EOPS Application

Please Select Semester Fall Spring Summer

I am a California Resident

I qualify to receive a Board of Governor's Waiver (BOGW) A or B

I am enrolled in 12 units

I have less than 70-degree applicable units.

I have completed the Assessment/Placement Tests for English and Math.

Last Name   

First Name  

Street         

City              Zip 

Social Security

Palomar ID#

Phone         

Email           

Male    Female   

Date of Birth

1. White/Caucasian

2. Black/African American

3. Hispanic/Mexican American

4. Asian, Pacific Islander, Southeast Asian

5. American Indian/Native American

6. Filipino

7. Other

Do you have dependent children Yes  No

If yes, ages of children

Marital Status: Please Select One Single Married Separated Divorced Widowed

TANF/CalWORKs Recipient?   For Your Self?  Yes       No For Your Children Only?   Yes  No

If yes when did your benefits begin?

Emancipated Foster Youth? Yes  No

If yes date you became emancipated?

Have you previously been enrolled in remedial education Yes No

Do you have a High School Diploma  G.E.D. None

Was your H.S. G.P.A. below 2.5? Yes  No

Are you enrolled in TRIO?   Yes  No

Have you Applied for the  FAFSA?   Yes  No

Are your parents Native English speakers? Yes No

Are you a Native English speakers? Yes No

Do either of your parents have a 4-year college degree? Yes No

Do you have a disability? Yes No

If yes are you enrolled with DRC (Disability Resource Center)? Yes No 

Vocational State Rehabilitation? Yes No

Have you completed units at Palomar College? Yes No

Total Units

Previous EOPS Student Yes No

Have you completed units at any other college? Yes No

List Colleges:                             Total Units    Transcripts at Palomar

    Yes No

    Yes No

    Yes No

What is your educational goal at Palomar College?

Please Select One Transfer without AA Transfer with AA Vocational AA degree Other AA degree Certificate/License Other

If selected other please specify:

Major

By submitting this application you are confirming that all the information is True and Correct.