EOPS
Extended Opportunity Programs and Services
Phone (619) 660-4204 Fax: (619) 660-4279
Borderless Spaces
CARE
CAYFES
DSPS
First Year Experience
UP!
Eligibility Requirements
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Office Use Only
I am a California resident & am enrolled in 12 or more units (DSPS participants may have 9 -12 units)
I have applied and be eligible for the Board of Governors Fee Waiver (BOGW) A or B
Have not completed more than 70 degree applicable units
I have completed the Math and English Placement Tests
I have submitted or will submit copies of transcripts of coursework taken at other colleges or universities
YOU MUST Meet the Educational Disadvantage Criteria as set by the State
Please answer Part A legibly in black or blue ink, then answer Part B, and sign at the bottom
Resident
 Yes
 No
Enrolled Units _____
BOGW
A☐
B☐ C☐
0 EFC
PART A:
Name: ____________________________________________________ Student ID ______________________
Last
First
Middle Initial
Address: __________________________________________________________________________________
Street
City
Zip Code
Cell: ____________________________ Phone: ______________________ Male__ Female __ Transgender __
(Check One)
Email: ___________________________________________________ Date of Birth: ______________________
PART B
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
Have you been to college before?
 Yes  No
I have been at Cuyamaca College

I have been to another college

EOPS Status (Check one)
I have never been in an EOPS program

I was in EOPS here at Cuyamaca College

I was in an EOPS program at another college

Do you have a high school diploma, OR GED OR Certificate of Proficiency?
If yes: High school graduated from ____________________________________
GPA________
Are you a participant in the Disabled Student Programs and Services (DSPS)?
 Yes  No
Are you a current or former foster youth, youth raised in Guardianship or a homeless youth?  Yes  No
Are you a single parent receiving TANF/CalWORKs?
 Yes  No
Are you an AB540, Dream Act, or DACA student? [information is confidential]
 Yes  No
Are you a participant of First Year Experience?
 Yes  No
Have you completed units at another college or university outside of GCCCD?
 Yes  No
If yes: Have you provided transcripts to Admission and Records?
 Yes  No
Have your parents or guardians received a degree from a 4-year college/university?
 Yes  No
Is there a language spoken at home other than English?
 Yes  No
Have you applied for Federal Student Financial Aid?
 Yes  No
Racial/Ethnic Background (check one)
14. Educational goals
 Transfer to a 4-yr university
 African American
 Associate Degree
 American Indian or Alaskan Native
 Vocational/CTE Major
 Asian or Pacific Islander
 General Education
 Caucasian or White
 Certification
 Filipino/a
 Job Skill Development
 Middle Eastern (Iraqi, Syrian, Turkish, etc.)
 ESL Development
 Latino/a (Mexican, Puerto Rican, Cuban, other Latin American)
 Other __________________________________________
Units Completed
CC
___
Other
___
Total
___
 Ethnicity
Ed. Disadvantage
#1 Below Min
Engl/Math for AA
#2 No HS/GED/Crt
#3 HS GPA↓2.5
#4 Prior Enroll in
remedial courses
#5 Other Factors
st
1 generation
Underrep/Disprop Imp
nd
Stud/par Engl is 2 lang
Foster youth
Test Scores
Engl
__________
ESL
__________
Math
__________
Other Trns ________
Reviewer Initials/Date
____ ___/___/___
____ ___/___/___
INELIGIBLE
Initials ______
Date ______
 Residency
 BOGW
 Ed. Disadvantage
 Less than 12 units
15. What are you studying? What is your major? _____________________________________
 Over Units
Student Signature ________________________________________________ Date: _____________________
 Petition Denied
EOPS Assistant Dean Use Only
 Units
 BOGW
 Assessmentt Math/English
APPROVED Signature:
 Other
Transcripts
 Transcripts not on file
 EOPS Group Orientation
Petition  Approved  Denied
 EOPS Online Orientation
 DSPS Verification Letter
DSPS Units _____ Date _____
Date:
Revised 2/16/16 EV