Ujima Scholars Interest Form

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Ujima Scholars is a learning community designed to enhance the experience of African-American Students through counseling, instruction, mentoring and community building. We provide personalized academic and social support, financial assistance with expenses such as textbooks, transportation, and technology, a strong sense of community, and mentorship. After you complete the interest form, you will receive a short contract regarding joining Ujima Scholars

Name *

Student Email *

Student ID# *

Phone number

Race/Ethnicity

American Indian/ Alaskan native

Asian

Black

White

Chicano

This is my first time attending college

Yes

No, I have attended college previously and have completed more than 20 units of college coursework

No, I have attended college previously, but I have completed less than 20 units of college coursework

Clear selection

I will be the first in my family to complete a college degree

Yes

Clear selection

I want to enroll at College of the Canyons full-time

Yes

Clear selection

I am interested in joining the Ujima Scholars Counseling 150 and English 101 Cohort in the Fall 2023

Yes

Clear selection

I am majoring in the following areas

Science Technology, Engineering, and Math (STEM)

Social Sciences (Psychology, Sociology, Political Science, etc.)

Humanities (English, Anthropology, History, etc.)

Arts (Music, Studio Arts, Photography, etc.)

Other:

Clear selection

I have applied for Financial Aid through FAFSA or California Dream Act Application

Yes

Clear selection

If you have not applied for Financial Aid through the FAFSA or California Dream Act Application would you like assistance in completing this process?

Yes

Clear selection

Are you employed?

Yes

Clear selection

Have you ever worked with an IEP or 504 Plan during your K-12 studies, or do you think you have a physical, mental, emotional, or learning difference that may make you eligible for academic accommodations?

Yes

Clear selection

Are you experiencing challenges finding a safe place to live?

Yes

Clear selection

What type of transportation do you primarily use?

Public Transportation (Metro Bus, Metro Rail, etc.)

I drive myself in a car or motorcycle

A friend or family member gives me a ride

apps

Other:

Clear selection

I have access to my own reliable laptop or tablet at home to complete school work?

Yes

Clear selection

I have access to reliable Internet service and Wi-Fi at home?

Yes

Clear selection

I have access to nutritious food everyday

Yes

Clear selection

I am eligible for CalFresh?

Yes

Not sure

Clear selection

I plan to register for courses which will require me to purchase textbooks?

Yes

Clear selection

Are you currently in any other programs at COC?

Veterans

Student Athlete

EOP&S

Other:

Clear selection

Submit

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