KEAS Program Application Fall 2019

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The KEAS Program is now accepting applications for students interested in being part of our program in Fall of 2019.
In completing this form, you will be asked to RSVP to one of the KEAS Info Sessions.

***If you are a new student or you did not attend ECC in the Spring 2019, you must register for El Camino College prior to applying to the KEAS Program.

Questions? Call 310-660-3593 x7716

Email *

ECC Email Address *

First Name *

Last Name *

ECC Student ID Number *

Date of Birth *

(MM/DD/YYYY)

Gender *

Male

Female

Other:

Main Contact Phone Number *

Alternate/ Home Phone Number

Home Address *

City *

State *

Zip Code *

How do you identify? (Check all that apply) *

American Indian or Alaska Native

Asian

Black or African American

Hispanic or Latino

Native Hawaiian or Pacific Islander

White

Multiracial

Other:

Required

Are you a member or a participant in any of the following programs? *

First Year Experience (FYE)

Project Success

Puente

EOPS

Special Resource Center

Guardian Scholars (Current or Former Foster Youth)

Veterans Services Program

MESA

Honors Transfer Program

MANA

South Bay Promise

Athletics

I am not in any other program on campus.

Other:

Required

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