Please complete this application along with all required documentation in-person to the EOPS, TRIO, and CalFresh office(s). 
Applicants will be individually notified by each office ONLY if they've been selected for that particular program.

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* 1. Application Status

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* 2. First Name

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* 3. Middle Initial

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* 4. Last Name

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* 5. S-Number

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* 6. Date of birth

Date / Time

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* 7. Siskiyous e-mail

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* 8. Phone number 

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* 9. College of the Siskiyous can text this phone number for information regarding program services and updates.

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* 10. Gender

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* 11. What is the primary language spoken in your home?

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* 12. Please check as many races as you identify with from the list provided:

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* 13. Are you a legal permanent resident or a US citizen?

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* 14. Are you a California resident? (lived in CA for at least 12 months)
Due to state-level regulations, only California residents are eligible to receive EOPS services.  Therefore, if you are not a California resident, you will not be receiving a response from the EOPS program.

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* 15. Are you a US military veteran or dependent of a military veteran?

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* 16. Are you currently homeless or foresee being homeless in the future?

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* 17. Are you a current or former foster youth?

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* 18. Are you Ward of the Court or have ever been in Kinship/Guardianship care?

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* 19. Are you working and getting paid for at least 20 hours per week OR a total of 80 hours a month on average?

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* 20. Have been you approved for or awarded federal/state work study for the current term?

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* 21. Are you enrolled in a state funded program such as EOPS, DSPS, or CARE?

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* 22. Which best describes you?

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* 23. What is your education goal?

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* 24. Have you attended any other colleges/universities?
If so, please provide official transcripts to the EOPS office.

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* 25. Was your high school GPA under 2.5?

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* 26. To the best of your knowledge, have either of your parents/adoptive parents received a bachelor's degree?

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* 27. Do/Did you have an IEP or 504 in High School?

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* 28. By typing my name below, I: (i) certify that the information I have submitted is true, complete, and correct; (ii) authorize the above programs to record pertinent facts regarding my eligibility in the program, services rendered and post-secondary education enrollment; (iii) authorize the release of my student information for programs' needs; (iv) and understand that failure to fulfill any required student responsibilities may result in loss of services provided. By clicking on the 'I accept' below, I acknowledge and understand the about 'terms of agreement.'

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