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.

Question Title

* 1. First Name

Question Title

* 2. Middle Initial

Question Title

* 3. Last Name

Question Title

* 4. S-Number

Question Title

* 5. Date of birth

Date

Question Title

* 6. Siskiyous e-mail

Question Title

* 7. Phone number 

Question Title

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

Question Title

* 9. Gender

Question Title

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

Question Title

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

Question Title

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

Question Title

* 13. 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.

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

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

Question Title

* 19. Are you eligible for federal work study?

Question Title

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

Question Title

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

Question Title

* 22. Which best describes you?

Question Title

* 23. What is your education goal?

Question Title

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

Question Title

* 25. Was your high school GPA under 2.5?

Question Title

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

Question Title

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

Question Title

* 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.'