Thank you for your interest in joining UC Riverside's Early Academic Outreach Program! Our mission is to work with current high school students to help prepare them for the college admissions process.
 
Please be sure to check our list of current service high schools and community based partners to ensure you are eligible to apply. If you have questions about this, or any other part of this survey, please contact eaop@ucr.edu.

Student's Birthdate

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* 1. Student's Birthdate

Date
Students Gender

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* 2. Students Gender

Student's Legal Last Name

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* 3. Student's Legal Last Name

Student's Legal First Name

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* 4. Student's Legal First Name

Student's Legal Middle Name

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* 5. Student's Legal Middle Name

Student's Legal Suffix (Jr., III., etc.)

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* 6. Student's Legal Suffix (Jr., III., etc.)

Student's Mailing Address

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* 7. Student's Mailing Address

Student's E-mail Address
  • All communication from EAOP, such as imporant updates and invitations to workshops and events, is done via e-mail. Without an e-mail address, you may miss out on important information from our program.
  • If you do not have an e-mail address, you may enter your parent/guardian's e-mail address with their permission, your high school may have already created one for you, or there are many free providers, such as GMail or Yahoo, where you can create your own.

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* 8. Student's E-mail Address
  • All communication from EAOP, such as imporant updates and invitations to workshops and events, is done via e-mail. Without an e-mail address, you may miss out on important information from our program.
  • If you do not have an e-mail address, you may enter your parent/guardian's e-mail address with their permission, your high school may have already created one for you, or there are many free providers, such as GMail or Yahoo, where you can create your own.

Student's Primary Home Phone Number
(Enter phone number with only numbers: ##########)

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* 9. Student's Primary Home Phone Number
(Enter phone number with only numbers: ##########)

Student's Cell Phone Number (if available)

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* 10. Student's Cell Phone Number (if available)

What is the primary language spoken in your home?

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

Current Grade Level (for 2017-2018 academic year)

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* 14. Current Grade Level (for 2017-2018 academic year)

Are you eligible for the school's free or reduced fee meal program?
(This question is for informational purposes only. Eligibility for free or reduced lunch is not a requirement to join EAOP.)

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* 15. Are you eligible for the school's free or reduced fee meal program?
(This question is for informational purposes only. Eligibility for free or reduced lunch is not a requirement to join EAOP.)

Parent / Legal Guardian 1 Information

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* 16. Parent / Legal Guardian 1 Information

Parent / Legal Guardian 2 Information

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* 18. Parent / Legal Guardian 2 Information

Family Size (including student)

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* 20. Family Size (including student)

Is the household a single parent home?

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* 21. Is the household a single parent home?

Please read the following information carefully:
After clicking the submit button below you will be redirected to a waiver packet that is required as a part of the EAOP enrollment process. The packet must be completed by the student and a parent / legal guardian. Instructions on completing the document can be found on the first page. Your application to enroll in EAOP is not complete until our office receives these documents. If you have any questions, please contact EAOP at eaop@ucr.edu.

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* 23. Please read the following information carefully:
After clicking the submit button below you will be redirected to a waiver packet that is required as a part of the EAOP enrollment process. The packet must be completed by the student and a parent / legal guardian. Instructions on completing the document can be found on the first page. Your application to enroll in EAOP is not complete until our office receives these documents. If you have any questions, please contact EAOP at eaop@ucr.edu.

If you were referred to EAOP by a current senior at your high school, indicate the first and last name of that student here. If not, leave blank.

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* 24. If you were referred to EAOP by a current senior at your high school, indicate the first and last name of that student here. If not, leave blank.

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