EAOP Enrollment Form 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. OK Question Title * 1. Student's Birthdate Student's Birthdate Date OK Question Title * 2. Students Gender Male Female Different Identity OK Question Title * 3. Student's Legal Last Name OK Question Title * 4. Student's Legal First Name OK Question Title * 5. Student's Legal Middle Name OK Question Title * 6. Student's Legal Suffix (Jr., III., etc.) OK Question Title * 7. Student's Mailing Address Number & Street City Zip Code OK Question Title * 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. Please indicate an e-mail address that you check frequently below. 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. OK Question Title * 9. Student's Primary Home Phone Number(Enter phone number with only numbers: ##########) OK Question Title * 10. Student's Cell Phone Number (if available) OK Question Title * 11. Ethnicity African American / Black American Indian / Alaskan Native Chinese / Chinese-American East Indian / Pakistani Filipino / Filipino-American Japanese / Japanese-American Korean / Korean-American Mexican / Mexican-American / Chicano Pacific Islander Vietnamese / Vietnamese-American White / Caucasian (including Middle Eastern) Other Asian (not including Middle Eastern) Other Spanish-American / Latino Other OK Question Title * 12. What is the primary language spoken in your home? OK Question Title * 13. Student's High School Adelanto Arlington Canyon Springs Citrus Hill Colton Eisenhower Fontana Hesperia John W. North Kaiser La Sierra Moreno Valley Norte Vista Perris Ramona Rancho Verde Rialto Sherman Indian San Jacinto Silverado Valley View Victor Valley Vista Del Lago Wilmer Amina Carter Other (please specify) OK Question Title * 14. Student's High School ID Number OK Question Title * 15. Current Grade Level (for 2020-2021 academic year) 9 10 11 12 OK Question Title * 16. 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.) Free Reduced Only Neither OK Question Title * 17. Parent / Legal Guardian 1 Information First and Last Name Cell Phone Number Email Address Gender (M/F) Relationship to Student OK Question Title * 18. Parent / Legal Guardian 1 Highest Level of Education Completed Unknown or Not Available Never Attended School Attended Six Years or Less Attended Junior High Finished Junior High Attended Some High School High School Graduate General Education Diploma (GED) Attended Some College or University Associates of Arts Degree Awarded Bachelor's Degree Awarded (BS, BA, etc) Master's Degree Awarded (MA, MBA, MS, etc) Doctorate Degree Awarded (PhD, MD, EdD, etc) OK Question Title * 19. Parent / Legal Guardian 2 Information First and Last Name Cell Phone Number Email Address Gender (M/F) Relationship to Student OK Question Title * 20. Parent / Legal Guardian 2 Highest Level of Education Completed Unknown or Not Available Never Attended School Attended Six Years or Less Attended Junior High Finished Junior High Attended Some High School High School Graduate General Education Diploma (GED) Attended Some College or University Associates of Arts Degree Awarded Bachelor's Degree Awarded (BS, BA, etc) Master's Degree Awarded (MA, MBA, MS, etc) Doctorate Degree Awarded (PhD, MD, EdD, etc) OK Question Title * 21. Family Size (including student) OK Question Title * 22. Is the household a single parent home? No Yes Decline to Answer OK Question Title * 23. Total Family Income $15,443 or less $15,444-$20825 $20,826-$26,207 $26,208-$31,589 $31,590-$36,971 $36,972-$42,353 $42,354-$47,748 $47,749-$53,157 Decline to State OK Question Title * 24. 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. Additionally, our office also requires that you submit your most recent transcript (either an unofficial transcript or a print out of your grades from your school's online portal).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. I have read the above information. OK DONE