College Assistance Migrant Program (C

Student’s Last Name, First Name CSULB Number

CAMP Eligibility Information: In order to be eligible for services provided by College Assistance Migrant Program, either the student or their *immediate family member must be a seasonal or migrant farm worker or a dependent of a seasonal or migrant farm worker under the guidelines established by the Federal Migrant Education Program.

“Seasonal farm worker” means a person who was employed in farm work and whose primary employment was in farm work on a temporary or seasonal basis (not a constant year-round activity). “Migrant farm worker” means a person whose employment required travel that prevented him or her from returning home within the same day. 1) The work must have been occurred within the last 2 years for at least 75 days. OR 2) You participated in the Migrant Education Program *Immediate Family includes, Parent, Spouse, Step Parent, Adoptive Parent, Foster Parent, anyone with Guardianship, Grandparents, Uncles, Aunts, etc. and claims you as a dependent on their taxes OR your relative must reside for either of the previous 2 years in the same household as you and supports you financially. In addition, you must be enrolled as a full-time student at CSULB; not be beyond your first year, be a California resident, with U.S. citizenship or a legal permanent resident.

CSULB, College Assistance Migrant Program (CAMP) Application

All information will be kept confidential & used only for determining your eligibility to the program Personal Information:

Address: City: State: Zip Code:

Home Phone Number: Cell/Message Number: Date of Birth:

Male/Female E-Mail Address/es

Citizenship Information:

Are you a U.S. Citizen?: YES NO Are you a 1st Generation College Student?: YES NO (Neither parent has a college degree)

Are you a permanent resident? YES NO SAT Score: ACT Score:

A # (only if applicable): Other Data:

How did you hear about CAMP? What High School did you graduate from? Pg1 Two ways to qualify for CAMP (Fill out only A or B) A You or any member of your *immediate family performed agricultural or farm work for 75 days or more within the last 2 years.

Agricultural Activity related to: - The production of crops, dairy products, poultry, or keeping, grazing, feeding or selling of livestock - Production of bulbs, flower seeds, vegetables, plants or vines - Cultivation or harvesting of trees, sod farms, nurseries, orchards, mushroom cellars, & cranberry bogs - Fish farms Farmwork: - Any agricultural activity, performed for either wages or personal subsistence, on a farm, ranch, or similar establishment Name of Family member(s) that worked: Relationship to you:

Please circle ONLY one: 1.) Immediate family member claimed you as a dependent (attach 1040 tax form) OR 2.) Immediate family member resides with you while he/she was doing migrant related farm work (please attach rental receipt, other related documents or fill out dates below.) Immediate Family member’s Address and City of residence Dates that immediate family resided with you

List the most recent and accurate information for type of farm work or migrant field work performed Start End Type of Work Performed (I.E.: Name and address of Employer (I.E.: Was the work seasonal or migrant? Date Date Picking grapes, apples, etc. Farm, Ranch, Nursery, etc.)

I certify that I am eligible for the CSU-Long Beach CAMP and that the above information is complete and accurate according to our records. I further understand that any false statement will subject me to immediate dismissal from the program (Note: If this document is e-mailed, please sign the copy to be filed in the CAMP office).

Print Name Applicant Signature (If you are under 18 years of age, a parent signature is required) Date

You must have participated or be *eligible to participate in the federal Migrant Education Program (MEP) B * If you or anyone in your immediate family is currently doing Migrant or Seasonal work, contact your local MEP to acquire COE.

My MEP Certificate of Eligibility (COE) number is: (Please attach a copy of your COE or other related documents.)

I certify that I am eligible for the CSU-Long Beach CAMP and that the above information is complete and accurate according to our records. I further understand that any false statement will subject me to immediate dismissal from the program (Note: If this document is e-mailed, please sign the copy to be filed in the CAMP office).

Print Name Applicant Signature (If you are under 18 years of age, a parent signature is required) Date

For CAMP Office Use Only:

Please verify that each applicant has completed all related sections of this application. Due to the competitive acceptance process into CSULB, the student must confirm their acceptance into CSULB, including the “Intent to Enroll” form before they are officially considered to be part of the College Assistance Migrant Program.

CAMP Staff (Name & Signature) Title Date

Pg2 CAMP Director’s Approval (Name & Signature) Date Pg3

CSULB CAMP Important Deadlines:

Note: Currently CSULB CAMP does not have an application deadline. Our only urgency is that you confirm your acceptance to the university prior to us being able to accept you into the College Assistance Migrant Program.

1. CAMP Application Deadline Ongoing/None 2. CAMP Alternative Admissions Application Deadline March 2nd 3. SAT/ACT Test Deadline December (of your H.S. senior year) 4. CSULB Application Deadline October 1st - November 30th (of your H.S. senior year) a. CSULB Intent to Enroll Deadline May 1st b. CSULB Enrollment Deposit Due May 1st 5. EOP Application Deadline March 2nd 6. ELM/EPT Placement Test Deadline June 18th 7. Attend CSULB Required “SOAR” Orientation Summer before 1st College Fall Semester

CSULB CAMP Document Checklist:

Completed Documents Date Completed CAMP Application CSULB Application: Online at CALSTATE.EDU/APPLY

EOP Application: To be considered for EOP you must indicate your interest in the program by checking the appropriate section on the CSU application. Once you have submitted your on-line University application you will be able to fill out the EOP Application on Cal State Apply. Your EOP file will be complete once we have received the completed Applicant Information Form and two Recommendation Forms. Supporting Eligibility Documents: Completed and signed “CAMP Eligibility Information” (page 2 or 3) of this CAMP application, Certificate of Eligibility (COE), copy of paycheck, copy of tax forms, letter from employer, etc. Financial Aid FAFSA Application: Online at FAFSA.ED.GOV

Student Notes:

CSULB, College Assistance Migrant Program, 1250 Bellflower Blvd., LA 3-202, Long Beach, CA 90840 Phone: 562-985-2006, Fax: 562-985-2003, Recruiter: 562-985-2002 WWW.CSULB.EDU/CAMP

Pg3 Revised: 10-13-2010 (ARH)