college assistance migrant program application.pdfthe college assistance migrant program ... camp...

College Assistance Migrant Program

2018 - 2019 Application

The College Assistance Migrant Program (CAMP) at California State University, Bakersfield is a federally funded program designed to meet the needs of students with migrant and seasonal farm working backgrounds. CAMP offers eligible students pre-college transition and first-year support services to help develop the skills necessary to succeed in college. CAMP collaborates with CSUB faculty, student services and community-based agencies to enhance educational career opportunities for all CAMP eligible students. CAMP and its staff are committed in helping its students succeed at CSU, Bakersfield. CAMP students will become immersed with valuable information to assist them in their first year of higher education.

Please submit your application to the address listed below:

College Assistance Migrant Program California State University, Bakersfield

70 LOR 9001 Stockdale Highway

Bakersfield, California 93311

PHONE: (661) 654-3212 FAX: (661) 654-6521

WEBSITE: www.csub.edu/camp E-MAIL: [email protected]

* CSU Fresno * CSU Long Beach * CSU Monterey Bay * CSU Sacramento * CSU San Marcos * * Santiago Canyon College * Mendocino Community College * West Hills College *

College Assistance Migrant Program-Application-Page 1

PERSONAL INFORMATION

Date:

Name:MaleFemale

Last First Middle

Mailing Address: City: Zip Code:

Birth Date: Birthplace:

Contact Phone Number:

U.S. Citizen Permanent Resident:

Ethnic Background: (please select one)

African-AmericanFilipino

Anglo-AmericanHispanic/Latino/Chicano

Asian-Pacific IslanderNative American Indian

Other:

EDUCATION

1. Which high school do/did you attend? City:

2. When did you -or- when will you graduate from high school or complete your GED? Month: Year:

3. Are you -or- have you ever been a participant of the Migrant Education Program?

Elementary School

High School

Middle School

Not Applicable

5. At CSU,Bakersfield - what do you plan to study (major)?

4. Expected to Attend CSUB: Fall Term Spring Term Year:

8. Have you applied for the CSUB Educational Opportunity Program (EOP)?

9. List colleges and universities previously attended, if any:

Name of Institution: Location:

Name of Institution: Location:

E-Mail:

Please provide Alien Registration Number

If YES, when?: (check all that apply)

Alien Registration Number:

2018-2019 2019-2020 2020-2021Cohort Year:

Home Address: City: Zip Code:

Residency Status:

6. Have you taken the SAT / ACT Test?NO

YES

If NO, Date expected to take exam:

7. Have you applied for Federal Student Aid (FAFSA)? NOYES

1. Name(s) of Parent(s) -or- Legal Guardian:

Father: Mother:

Occupation:

2. Highest grade level completed by: Father: Mother:

Occupation:

Name: Relationship:

Occupation:

From: MM / DD / YYYY

Type of Work:

Company/Employer Name: Phone:

Employer Address:

Name of who worked:

Parent Home Phone: Parent Cell Phone:

Contact Phone Number:

To: MM / DD / YYYY

Dates Employed:

From: MM / DD / YYYY

Type of Work:

Company/Employer Name: Phone:

Employer Address:

Name of who worked:

To: MM / DD / YYYY

Dates Employed:

FAMILY INFORMATION

WORK HISTORY


Immediate Family Member Information (if applicable for CAMP eligibility)

AUTOBIOGRAPHICAL STATEMENT

On separate sheet(s) of paper, please type an essay of one to two pages describing: -Why an education is important to you? -What motivates you to succeed academically? -Who has motivated you to do well in school? -How would you benefit from the CAMP services? *You may add additional comments that you would like us to know about you. Your autobiographical statement is an important part of your application, so be sure to take the time to write a well-thought out autobiography.

I understand that it may be necessary for CAMP Staff to obtain records from other CSU, Bakersfield departments in order to verify by current academic and financial status. I give permission for such records to be obtained. By signing below, I hereby certify that all statements made on this application and all other documents I have submitted in support of my CAMP application are true and complete to the best of my knowledge.

Student Signature: Date:

Eligible for CAMP: YES NO

Date of Eligibility:

If not eligible, explain why?

If eligible for CAMP, verification used: Employment Verification Form w/ Pay Stubs (Parent, Self or Immediate Family member)

Migrant Education Certificate of Eligibility COE No. :

CAMP Director:

***FOR OFFICE USE ONLY ***

T-shirt Size:

Explain:

Non-Vegetarian

Vegetarian

Other

Meal Preference: (select one)

Food Allergies Explain:


ADDITIONAL INFORMATION

SIGNATURE

NOTE: All applicants must meet the CSUB admissions eligibility requirements prior to being considered for the CSUB College Assistance Migrant Program (CAMP)

Part of your commitment to the College Assistance Migrant Program is to attend our Mandatory Summer Program. A two week program designed to assist you with the transition from High School to University. During the summer program you will receive a CAMP t-shirt as well as meals.

T-shirt Preference: (select size)

CAMP Recruiter: Date of Review:

Migrant Education Certificate of Eligibility (COE)

Employment Verification Form w/ current Pay stubs

Two (2) Recommendation Forms

High School Transcripts

Test Scores

Autobiography

SAR (Student Aid Report)

CAR (California Aid Report)

Recruiter Verification: All of the following information has been collected to move forward to determine services and eligibility to the College Assistance Migrant Program at California State University, Bakersfield.

Consent for Release of Information

College Assistance Migrant Program - Recommendation Form California State University, Bakersfield

Please have an instructor or counselor complete a recommendation form.

Student Name:

Recommender's Name: Title:

School:

Address/City/Zip:

Phone Number:

Phone Number:

ACADEMIC EVALUATION

In order to provide appropriate program services to meet the needs of the applicant, please provide feedback as to the applicant's academic needs and potential to succeed at the university level.

Signature: Date:

Additional Comments:

the university level?

1. How do you know this student and for how long?

2. Do you know of any specific academic needs that we can assist the student with?

3. Are you aware of any barriers that the applicant possesses that could affect his/her academic performance at

INSTRUCTIONS TO THE STUDENT If you would like to be considered for admission into CAMP, please complete the Employment Verification Form as required. You will need this form if you do not have a Migrant Education Certificate of Eligibility. Please ask the employer to complete this form and return form back to you. In addition, please submit copies of the most recent pay stubs from the employer (Self, Parent or Immediate Family Member) Please respond as soon as possible so that we may begin determining your eligibility into the program. Remember, CSUB CAMP provides services to 75 students, therefore, openings are limited.

Dear Employer, The following student, _____________________________________, has applied to the College Assistance Migrant Program (CAMP) at California State University, Bakersfield. In order to be eligible for CAMP, the student, parent or immediate family member must be a migrant or seasonal farmworker (or the dependent of a migrant or seasonal farmworker). The student has indicated that the person listed below has been/was employed by you as a farm worker within a minimum of 75 days within the last two years. The purpose of the form is for you to verify his/her employment. After completing this form please return to: Student or Employee. Please note: For the purpose of this program, the farmwork may include any activity directly related to the production of crops, dairy products, poultry, or livestock, the cultivation of harvesting trees, or any activity related to fish farms. This farmwork includes work performed for either wages or personal subsistence on a farm, ranch, packing, or similar establishments.

Name of Employee:

From: To:

Type of Work Performed:

Dates Employed:

CERTIFICATION OF EMPLOYMENT

I certify that the information provided is complete and accurate according to our employment records.

Name of Company/Employer:

Mailing Address:

City/State/Zip: Telephone:

Position/Title:

Signature:

Date:

MM / DD / YYYY MM / DD / YYYY

Seasonal PermanentType of Employment (Check One):


EMPLOYMENT VERIFICATION FORM

VERIFICATION OF FARMWORKER EMPLOYMENT STATUS


Name:

Last First Middle

Date of Birth:

MM / DD / YYYY

I, the undersigned, authorize the following entity to release the following information from my records:

Address:

Phone Number:

Name of Entity:

(Mark all that apply):

Migrant Education Program - Copy of Certificate of Eligibility

High School Transcript

Employment Dates

Job Duties

Other Explain:

To assist with the documentation of eligibility to receive services from the College Assistance Migrant Program, U.S. Department of Education - Office of Migrant Education. This authorization shall remain effective during the recruitment process for the College Assistance Migrant Program at California State University, Bakersfield or until revoked in writing.

Date

Parent Signature (if under 18yrs of age) Date

Student Signature


APPLICATION TO DO LISTUse this check list to assist you in completing and submitting all documentation needed for your CAMP Application. All necessary documentation must be received before final acceptance can be determined.

A) ALL applicants MUST meet the CSUB Admissions eligibility requirements prior to being considered for the College Assistance Migrant Program (CAMP) B) CAMP ONLY has 75 available spaces each year; therefore, we recommend that you apply as early as possible. Should you have any questions, please feel free to contact the CAMP office at the number listed below.

Complete CAMP Application

Autobiography (see below)

Two (2) Recommendation Forms

Eligibility Documentation

Migrant Education Certificate of Eligibility (COE)

-OR-

Employment Verification Form w/ Current Pay stubs (Self, Parents or Immediate Family Member's)

-OR-

Certificate of Workforce Investment Act (WIA)

Please direct any correspondence to:

College Assistance Migrant Program

California State University, Bakersfield 70 LOR

9001 Stockdale Highway Bakersfield, CA 93311

PHONE: (661) 654-3212

FAX: (661) 654-6521 WEBSITE: www.csub.edu/camp

E-MAIL: [email protected]

High School Transcripts

Test Scores (EAP, SAT, ACT, AP)

Print out: SAR (Student Aid Report) & CAR (California Aid Report)

On separate sheet(s) of paper, please type an essay of one to two pages describing: -Why an education is important to you? -What motivates you to succeed academically? -Who has motivated you to do well in school? -How would you benefit from the CAMP services? *You may add additional comments that you would like us to know about you. Your autobiographical statement is an important part of your application, so be sure to take the time to write a well-thought out autobiography.


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