Staff Intake Process For Office Use Only Application Checklist Educational Qualifications Demographics BOGW A B Math Assessment____________________ Educationally SEP (current 2 sem) English Assessment__________________ – disadvantaged Enrollment (6+ units) Non High School Graduate or GED Foster youth CRC transcript Below 2.50 GPA Veteran Other transcripts Remedial Enrollment__________________ Timed-out TANF CalFresh verification Other______________________________ CalWORKs Transfer degree Date received: ____________ Staff initial:___________ Current Units Enrolled: ________ Start Term: ________ Assessment made on ____________ (date) by _____________________________ (name of staff) All assessment materials have been collected Assessment indicates that student has skills, interest, and capacity to benefit from Fresh Success. The Pre-Enrollment Form will be completed only after college-based eligibility has been determined. Assessment indicates that student IS NOT appropriate for Fresh Success. Notes: ___________________________________________________________________________________________
Staff Intake Process For Office Use Only Application Checklist BOGW A B SEP (current – 2 sem) Enrollment (6+ units) CRC transcript Other transcripts CalFresh verification Date received: ____________ Educational Qualifications Math Assessment____________________ English Assessment__________________ Non High School Graduate or GED Below 2.50 GPA Remedial Enrollment__________________ Other______________________________ Demographics Educationally disadvantaged Foster youth Veteran Timed-out TANF CalWORKs Transfer degree Staff initial:___________ Current Units Enrolled: ________ Start Term: ________ Assessment made on ____________ (date) by _____________________________ (name of staff) All assessment materials have been collected Assessment indicates that student has skills, interest, and capacity to benefit from Fresh Success. The Pre-Enrollment Form will be completed only after college-based eligibility has been determined. Assessment indicates that student IS NOT appropriate for Fresh Success. Notes: ___________________________________________________________________________________________
Fresh_Success_Intake_Application_0.docx