Fall 2021: MCCDC Additional Services Interest Form

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Please fill out this form if you are interested in our direct services program. Below is an outline of our services & PRIORITY eligibility requirements. Your responses will only be seen by MCCDC Staff.

MCCDC Additional Services Fall 2021
• Assistance with required textbooks (up to $350)
• Supply Support
• Academic support and counseling
• Requirements: 1 Orientation; 2 Counseling Appointments; 1 Workshop

Criteria for Additional Support Services
1. Complete Board of Governor’s Fee Waiver or FAFSA/CA DreamAct*
2. Receive the Board of Governor’s Fee Waiver or show financial need through FAFSA/CA DreamAct application
3. Register in at least 6 units at CSM
5. Have not completed an academic goal (A.A., AT. Or Certificate) or a first bachelors
6. Must not have completed more than 100 cumulative units
7. Must not be receiving book service from other campus programs (ex. EOPS or Promise Scholars Program)
8. Priority will go to continuing MCCDCAS program students who have complied with program requirements and in compliance with 1-8
*Please note that this year we are accepting applications from undocumented students that do not qualify for AB540 or CA Dream Act!!!
*Exceptions may be made for students in high unit majors
*Exceptions may be made for AB540/undocumented students, students with children, or Former Foster Youth

Last Name *

First Name *

G number *

Phone Number *

Email *

I am a Foster Youth, Former Foster Youth, or have been placed in court ordered out of home placement for at least one day in my life: *

Yes

Unknown

I am an Undocumented, AB540, Dreamer, and/or DACA Student *

Yes

Unknown

For Fall 2021 I AM receiving services from the following support programs: *

EOPS-Educational Opportunities Program

Promise Scholars Program

None of the Above

Unknown

Other:

Required

Do you now have—or will you have—children who will receive more than half of their support from you between July 1, 2021, and June 30, 2022? *

Yes

I am eligible for financial aid (Check all that apply) *

California College Promise Grant (CCPG)/BOGW

California Dream Act

FAFSA

None of the Above

Unknown

Required

The Multicultural & Dream Center is rooted in social justice, community empowerment and activism. What do those values mean to you? *

En Español: El Multicultural & Dream Center mantiene sus raíces en la justicia social, el empoderamiento comunitario y el activismo. ¿Qué significan esos valores para ti?

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