Enrollment Information

Term Summer/Fall 2020

Educational Goal Undecided on goal

Major/Program area of study Accounting

Account Information

OpenCCC Account

Name mark lee

Permanent Address No permanent address (homeless)

Previous Name

Preferred Name

Main Phone (419) 859-3776

Ext:

Second Phone Ext:

Email puamarakdia@gmail.com

Social Security Number Not Provided

Date of Birth May 9, 1992

Mailing Address

No current mailing address (homeless)

Education

Enrollment Status as of 06/07/2020 First-time student in college (after leaving high school)

High School Education Level as of Not a graduate of, and no longer enrolled in high school

Neither Received a diploma or certificate of completion in California

Neither Attended high school in California for three or more years

Grade Point Average

Highest English Course Taken

Highest English Course Grade

Highest Math Course Taken

Highest Math Taken Grade

Citizenship/Military

Citizenship Status U.S. Citizen

Military Status as of 06/07/2020 None apply to me

Residency

Yes Lived in California Continuously since 06/07/2018

No Since 06/07/2018 declared residency in another state for state income tax purposes
No Since 06/07/2018 voted or registered to vote in another state

No Since 06/07/2018 declared residency at an out-of-state college or university

No Since 06/07/2018 petitioned for a lawsuit or a divorce as a resident in another state

No Have you ever been in court-ordered foster care?

Needs and Interests

Yes Comfortable reading and writing English

Yes Would like information about money for college

Yes Receive TANF/CalWORKs, SSI, or General Assistance

Programs and services in which you are interested

No Academic Counseling/Advising

No Athletics/Intercollegiate Sports

No Basic Skills (reading, writing, math)

No CalWorks

No Career Planning

Yes Child Care

No Counseling - Personal

No DSPS - Disabled Student Programs and Services

No EOPS - Extended Opportunity Programs and Services

No ESL - English as a Second Language

Yes Health Services

No Housing Information

No Employment Assistance

No Online Classes

No Re-entry Program (after 5 years out)

No Scholarship Information

No Student Government

No Testing, Assessment, Orientation

No Transfer Services

Yes Tutoring Services

No Veterans Services

Demographic Information

Gender Male

Parent/Guardian Education Levels 1: UNKNOWN

2: UNKNOWN

Hispanic/Latino No
Race White
Canadian

Supplemental Questions

If you attended a K-12 school in California, and you know your 10 digit California Statewide Student ID (SSID), enter it here.

Including your SSID is not required, but if you

have one it is helpful for the college to have a
record of it. The SSID may be printed on your
California public high school transcripts or
other school documentation. [10 digit]

Primary Language

Please select your primary language: English

Barriers to Employment

Having a record of an arrest or conviction can

sometimes make it difficult to find
employment. Have you been subject to any
stage of the criminal justice process that has
created a barrier to employment?

Sometimes there are cultural barriers that

make it difficult for some to find
employment. These barriers can include
language, religion or ways in which people
communicate. Do you feel as though you
have had difficulty finding employment
because of cultural barriers?

You may exempt from the enrollment steps if you meet the criteria below. Any student exempted can still participate in these services at a
later date.

**IMPORTANT: Students planning to take * I am a new student but I wish to be exempt from one or more matriculation services.
courses with prerequisites must complete
assessment (AB705) and/or complete a
prerequisite challenge. Students who exempt
from Assessment, Orientation, or Counseling
will not receive registration priority.

I am requesting exemption because:

Neither I have already earned an A.A./A.S. degree or higher (at a U.S. accredited college or university)

Neither My educational goals do not include: transfer to a college or university, attainment of certificate,
degree or basic skills (i.e., math, English, ESL) or career development

Neither I am only enrolling in courses mandated by industry or licensure standards

I am requesting exemption from:

Neither ORIENTATION: Informational session about course placement, instructional programs, support
services, and registering for classes.

Neither ASSESSMENT: Evaluates your current Math and English/ESL skill levels. (Note: Students who exempt
from Assessment are still required to meet all program and course prerequisites.

Neither COUNSELING: Counselor recommendation on course selection and completion of an Educational

Plan.