Fall 2022: Academic Success Program Interest Form
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 Academic Support Program Services Fall 2022
• Assistance with required textbooks (up to $350)
• Supply & Transportation Support
• Academic support and counseling
• Requirements: Meet with MCCDC Counselor + MCCDC Programming/Event

Criteria for AS Program:
1. Register in at least 6 units at CSM
2. Have not completed an academic goal (A.A., AT. Or Certificate) or a first bachelors
3. Must not have completed more than 100 cumulative units
4. Must not be receiving book service from other campus programs (ex. EOPS or Promise Scholars Program)

*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
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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: *
I am an Undocumented, AB540, Dreamer, and/or DACA Student *
For Fall 2022, I AM receiving services from the following support programs: *
Required
Do you now have—or will you have—children who will receive more than half of their support from you between July 1, 2022, and June 30, 2023? *
Do you have financial need (need support with books, gas, etc.)? *
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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