* indicates a required field

Semester - TYPE S18 only *

Student ID- starts with 0 *

Enter Your Shasta College 7 digit Student ID #.

Last Name *

Enter your last name.

First Name *

Enter your first name.


Enter your middle initials.

Mailing Address *

Enter your mailing address.

City *

Enter your city of residence.

State *

Enter your state of residence.

Zip *

Enter your zip code.

Home Phone *

Enter Home Phone #.  Ex: 530-242-7540

Cell Phone *

Enter Cellular Phone #.  Ex. 530-242-7540

Email *

Enter email address.  Notice of acceptance will be sent to this email.

Gender *

Have you submitted a 2017-2018 BOGFW?

Check if you submitted a Board of Governors Fee Waiver (BOGFW) for the 2016-2017 school year to the Financial Aid Office?

Have you attended another college other than Shasta College?

Check if you've completed units at another college?

If yes, please make sure your other college transcript(s) is on file at our admissions and records office.

Other Names Used *

What other names have you used? If no other names used, enter N/A.

Received AA or Higher

Check if you've earned an AA/AS Degree or higher?

48 units or more

Check if you've completed more than 48 college units?

Have you previously participated in Shasta College EOPS?

Check if you've participated in EOPS before?

Semester exited EOPS *

If you participated in EOPS before, what semester did you last participate in? 

If you have not participated in EOPS before, enter N/A.

PT Student

Check if you will be attending Shasta College as a part time student (less than 12 units)?


Are you currently participating in the Disabled Students Programs and Services (DSPS)?

Is your high school cumulative GPA below 2.5?

Was your cumulative high school GPA below 2.5?

High School grad or equivalent

Will you be a high school graduate or obtain a GED or Proficiency Certificate by June 2017?

Are you a current, former, or an emancipated foster youth?

Check, if you are a current, former, or an Emancipated Foster Youth.

Remedial Courses

Are you currently enrolled in or have completed remedial level course(s) in college or high school?

Remedial Courses offered at Shasta College are level 200 or higher.

Father's education *

What is your father's educational background?

Father Ed. Explain *

If you selected Other or Unknown above, please explain here otherwise put N/A

Mother's education *

What is your mother's educational background?

Mother's Ed. Explain *

If you selected Other or Unknown above, please explain here otherwise put N/A

SC Goal *

What is your educational goal at Shasta College?

Refer to CARE

Check if you currently receive cash aid for yourself or a dependent child.

The CARE Program provides additional educational support services over and above EOPS.  Services includes: childcare and transportation reimbursements, additional textbook assistance, meal cards  and other educational related expenses to students who meet the eligibility criteria.

Child Under 14

Check if you have a dependent child under 14 years old.

Marital Status *

What is your marital status?

Last 4 SSN

Enter the last 4 digits of your Social Security Number

By entering that last four digits of my social security number,  I affirm that the information I have entered on this form is true and complete.  I understand that any false statement made on this application may result in penalties, including, but not limited to being denied EOPS/CARE services or having to make repayment for services already rendered.  I also authorize the release of any information on this application for communication between Shasta College, the Office of the Chancellor, Department of Social Services, Shasta County Office of Education and Early Head Start.