EOPS APPLICATION

EOPS/CARE/Nextup Program: 11460 Warner Avenue, Fountain Valley, CA 92708 Tel: (714) 241-6237

Dear potential EOPS student,

Thank you for your interest in the EOPS program. Please take time to answer all questions so we can best determine your eligibility for the EOPS program. Also please keep in mind that if you are accepted into the EOPS program you are required to meet with an EOPS counselor 3 times a semester and you will not receive a book voucher until you have met with an EOPS Counselor. If you have any questions about our requirements please give us a call at 714-241-6237.
SECTION I: STUDENT INFORMATION
YES
NO
Male
Female
Other
AA or AS degree
Transfer to University
Career/Technical Certificate
Undecided
Asian/ Pacific Islander
Black/African American
Hispanics of any race
Native American /Alaska Native
White
Multi-Race
SECTION II: ELIGIBILITY FOR PROGRAMS & SERVICES
1st time applying to EOPS
Returning EOPS Student (EOPS student at Coastline returning after not participating for at least one semester. "Note: You do not need to reapply if you are currently participating in the program.)
EOPS Transfer Student (current EOPS student from another community college campus)
Fall
Spring
Summer
YES NO
12 or more
9-11
below 9
YES NO
Graduate
Certificate of Proficiency
Non-graduate
G.E.D
YES NO
YES NO
YES NO
YES NO
SECTION III: CARE ELIGIBILITY
Cooperative Agencies Resources for Education (CARE) Program is a supplemental program to EOPS that is designed to provide the extra help a single parent may need to achieve their academic and career goals.
YES NO
SECTION IV: NextUp ELIGIBILITY
NextUp is a supplemental program housed within EOPS. It is designed to provide support services and other resources, including direct aid to current and former foster youth.
YES NO
SECTION V: CERTIFICATE

  • I understand that applying to the EOPS program does NOT mean that I am automatically accepted into the EOPS program.
  • I understand that even if I qualify for EOPS, I may not be accepted into the program because it is full.
  • I understand that the EOPS staff may take 5-7 business days to review my application.


I certify that the information that I have provided on the application is to the best of my knowledge, completed and accurate. I understand submission of an incomplete application and/or falsification will result in my application being denied or withdrawn. I grant Coastline College EOPS/CARE/NextUp office the authority to verify and/or obtain the records necessary to confirm the above information from schools and/or agencies. I also understand that it may be necessary to provide further documentation to determine my eligibility for the EOPS/CARE/NextUp program. I grant EOPS staff authorization to obtain records and data pertinent to my participation in other campus departments and programs and to release information to the CCC Chancellor's Office for the purpose of project performance reporting.