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First Name Middle Name Last Name Street Address City State/Province - Select -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyomingAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Postal Code Primary Email Address Home Phone United States+1United Kingdom+44Afghanistan (افغانستان)+93Albania (Shqipëri)+355Algeria (الجزائر)+213American Samoa+1Andorra+376Angola+244Anguilla+1Antigua and Barbuda+1Argentina+54Armenia (Հայաստան)+374Aruba+297Ascension Island+247Australia+61Austria (Österreich)+43Azerbaijan (Azərbaycan)+994Bahamas+1Bahrain (البحرين)+973Bangladesh (বাংলাদেশ)+880Barbados+1Belarus (Беларусь)+375Belgium (België)+32Belize+501Benin (Bénin)+229Bermuda+1Bhutan (འབྲུག)+975Bolivia+591Bosnia and Herzegovina (Босна и Херцеговина)+387Botswana+267Brazil (Brasil)+55British Indian Ocean Territory+246British Virgin Islands+1Brunei+673Bulgaria (България)+359Burkina Faso+226Burundi (Uburundi)+257Cambodia (កម្ពុជា)+855Cameroon (Cameroun)+237Canada+1Cape Verde (Kabu Verdi)+238Caribbean Netherlands+599Cayman Islands+1Central African Republic (République centrafricaine)+236Chad (Tchad)+235Chile+56China (中国)+86Christmas Island+61Cocos (Keeling) Islands+61Colombia+57Comoros (جزر القمر)+269Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)+243Congo (Republic) (Congo-Brazzaville)+242Cook Islands+682Costa Rica+506Côte d’Ivoire+225Croatia (Hrvatska)+385Cuba+53Curaçao+599Cyprus (Κύπρος)+357Czech Republic (Česká republika)+420Denmark (Danmark)+45Djibouti+253Dominica+1Dominican Republic (República Dominicana)+1Ecuador+593Egypt (مصر)+20El Salvador+503Equatorial Guinea (Guinea Ecuatorial)+240Eritrea+291Estonia (Eesti)+372Eswatini+268Ethiopia+251Falkland Islands (Islas Malvinas)+500Faroe Islands (Føroyar)+298Fiji+679Finland (Suomi)+358France+33French Guiana (Guyane française)+594French Polynesia (Polynésie française)+689Gabon+241Gambia+220Georgia (საქართველო)+995Germany (Deutschland)+49Ghana (Gaana)+233Gibraltar+350Greece (Ελλάδα)+30Greenland (Kalaallit Nunaat)+299Grenada+1Guadeloupe+590Guam+1Guatemala+502Guernsey+44Guinea (Guinée)+224Guinea-Bissau (Guiné Bissau)+245Guyana+592Haiti+509Honduras+504Hong Kong (香港)+852Hungary (Magyarország)+36Iceland (Ísland)+354India (भारत)+91Indonesia+62Iran (ایران)+98Iraq (العراق)+964Ireland+353Isle of Man+44Israel (ישראל)+972Italy (Italia)+39Jamaica+1Japan (日本)+81Jersey+44Jordan (الأردن)+962Kazakhstan (Казахстан)+7Kenya+254Kiribati+686Kosovo+383Kuwait (الكويت)+965Kyrgyzstan (Кыргызстан)+996Laos (ລາວ)+856Latvia (Latvija)+371Lebanon (لبنان)+961Lesotho+266Liberia+231Libya (ليبيا)+218Liechtenstein+423Lithuania (Lietuva)+370Luxembourg+352Macau (澳門)+853North Macedonia (Македонија)+389Madagascar (Madagasikara)+261Malawi+265Malaysia+60Maldives+960Mali+223Malta+356Marshall Islands+692Martinique+596Mauritania (موريتانيا)+222Mauritius (Moris)+230Mayotte+262Mexico (México)+52Micronesia+691Moldova (Republica Moldova)+373Monaco+377Mongolia (Монгол)+976Montenegro (Crna Gora)+382Montserrat+1Morocco (المغرب)+212Mozambique (Moçambique)+258Myanmar (Burma) (မြန်မာ)+95Namibia (Namibië)+264Nauru+674Nepal (नेपाल)+977Netherlands (Nederland)+31New Caledonia (Nouvelle-Calédonie)+687New Zealand+64Nicaragua+505Niger (Nijar)+227Nigeria+234Niue+683Norfolk Island+672North Korea (조선 민주주의 인민 공화국)+850Northern Mariana Islands+1Norway (Norge)+47Oman (عُمان)+968Pakistan (پاکستان)+92Palau+680Palestine (فلسطين)+970Panama (Panamá)+507Papua New Guinea+675Paraguay+595Peru (Perú)+51Philippines+63Poland (Polska)+48Portugal+351Puerto Rico+1Qatar (قطر)+974Réunion (La Réunion)+262Romania (România)+40Russia (Россия)+7Rwanda+250Saint Barthélemy+590Saint Helena+290Saint Kitts and Nevis+1Saint Lucia+1Saint Martin (Saint-Martin (partie française))+590Saint Pierre and Miquelon (Saint-Pierre-et-Miquelon)+508Saint Vincent and the Grenadines+1Samoa+685San Marino+378São Tomé and Príncipe (São Tomé e Príncipe)+239Saudi Arabia (المملكة العربية السعودية)+966Senegal (Sénégal)+221Serbia (Србија)+381Seychelles+248Sierra Leone+232Singapore+65Sint Maarten+1Slovakia (Slovensko)+421Slovenia (Slovenija)+386Solomon Islands+677Somalia (Soomaaliya)+252South Africa+27South Korea (대한민국)+82South Sudan (جنوب السودان)+211Spain (España)+34Sri Lanka (ශ්රී ලංකාව)+94Sudan (السودان)+249Suriname+597Svalbard and Jan Mayen+47Sweden (Sverige)+46Switzerland (Schweiz)+41Syria (سوريا)+963Taiwan (台灣)+886Tajikistan+992Tanzania+255Thailand (ไทย)+66Timor-Leste+670Togo+228Tokelau+690Tonga+676Trinidad and Tobago+1Tunisia (تونس)+216Turkey (Türkiye)+90Turkmenistan+993Turks and Caicos Islands+1Tuvalu+688U.S. Virgin Islands+1Uganda+256Ukraine (Україна)+380United Arab Emirates (الإمارات العربية المتحدة)+971United Kingdom+44United States+1Uruguay+598Uzbekistan (Oʻzbekiston)+998Vanuatu+678Vatican City (Città del Vaticano)+39Venezuela+58Vietnam (Việt Nam)+84Wallis and Futuna (Wallis-et-Futuna)+681Western Sahara (الصحراء الغربية)+212Yemen (اليمن)+967Zambia+260Zimbabwe+263Åland Islands+358 Invalid phone number Cell Phone United States+1United Kingdom+44Afghanistan (افغانستان)+93Albania (Shqipëri)+355Algeria (الجزائر)+213American Samoa+1Andorra+376Angola+244Anguilla+1Antigua and Barbuda+1Argentina+54Armenia (Հայաստան)+374Aruba+297Ascension Island+247Australia+61Austria (Österreich)+43Azerbaijan (Azərbaycan)+994Bahamas+1Bahrain (البحرين)+973Bangladesh (বাংলাদেশ)+880Barbados+1Belarus (Беларусь)+375Belgium (België)+32Belize+501Benin (Bénin)+229Bermuda+1Bhutan (འབྲུག)+975Bolivia+591Bosnia and Herzegovina (Босна и Херцеговина)+387Botswana+267Brazil (Brasil)+55British Indian Ocean Territory+246British Virgin Islands+1Brunei+673Bulgaria (България)+359Burkina Faso+226Burundi (Uburundi)+257Cambodia (កម្ពុជា)+855Cameroon (Cameroun)+237Canada+1Cape Verde (Kabu Verdi)+238Caribbean Netherlands+599Cayman Islands+1Central African Republic (République centrafricaine)+236Chad (Tchad)+235Chile+56China (中国)+86Christmas Island+61Cocos (Keeling) Islands+61Colombia+57Comoros (جزر القمر)+269Congo (DRC) (Jamhuri ya Kidemokrasia ya Kongo)+243Congo (Republic) (Congo-Brazzaville)+242Cook Islands+682Costa Rica+506Côte d’Ivoire+225Croatia (Hrvatska)+385Cuba+53Curaçao+599Cyprus (Κύπρος)+357Czech Republic (Česká republika)+420Denmark (Danmark)+45Djibouti+253Dominica+1Dominican Republic (República Dominicana)+1Ecuador+593Egypt (مصر)+20El Salvador+503Equatorial Guinea (Guinea Ecuatorial)+240Eritrea+291Estonia (Eesti)+372Eswatini+268Ethiopia+251Falkland Islands (Islas Malvinas)+500Faroe Islands (Føroyar)+298Fiji+679Finland (Suomi)+358France+33French Guiana (Guyane française)+594French Polynesia (Polynésie française)+689Gabon+241Gambia+220Georgia (საქართველო)+995Germany (Deutschland)+49Ghana (Gaana)+233Gibraltar+350Greece (Ελλάδα)+30Greenland (Kalaallit Nunaat)+299Grenada+1Guadeloupe+590Guam+1Guatemala+502Guernsey+44Guinea (Guinée)+224Guinea-Bissau (Guiné Bissau)+245Guyana+592Haiti+509Honduras+504Hong Kong (香港)+852Hungary (Magyarország)+36Iceland (Ísland)+354India (भारत)+91Indonesia+62Iran (ایران)+98Iraq (العراق)+964Ireland+353Isle of Man+44Israel (ישראל)+972Italy (Italia)+39Jamaica+1Japan (日本)+81Jersey+44Jordan (الأردن)+962Kazakhstan (Казахстан)+7Kenya+254Kiribati+686Kosovo+383Kuwait (الكويت)+965Kyrgyzstan (Кыргызстан)+996Laos (ລາວ)+856Latvia (Latvija)+371Lebanon (لبنان)+961Lesotho+266Liberia+231Libya (ليبيا)+218Liechtenstein+423Lithuania (Lietuva)+370Luxembourg+352Macau (澳門)+853North Macedonia (Македонија)+389Madagascar (Madagasikara)+261Malawi+265Malaysia+60Maldives+960Mali+223Malta+356Marshall Islands+692Martinique+596Mauritania (موريتانيا)+222Mauritius (Moris)+230Mayotte+262Mexico (México)+52Micronesia+691Moldova (Republica Moldova)+373Monaco+377Mongolia (Монгол)+976Montenegro (Crna Gora)+382Montserrat+1Morocco (المغرب)+212Mozambique (Moçambique)+258Myanmar (Burma) (မြန်မာ)+95Namibia (Namibië)+264Nauru+674Nepal (नेपाल)+977Netherlands (Nederland)+31New Caledonia (Nouvelle-Calédonie)+687New Zealand+64Nicaragua+505Niger (Nijar)+227Nigeria+234Niue+683Norfolk Island+672North Korea (조선 민주주의 인민 공화국)+850Northern Mariana Islands+1Norway (Norge)+47Oman (عُمان)+968Pakistan (پاکستان)+92Palau+680Palestine (فلسطين)+970Panama (Panamá)+507Papua New Guinea+675Paraguay+595Peru (Perú)+51Philippines+63Poland (Polska)+48Portugal+351Puerto Rico+1Qatar (قطر)+974Réunion (La Réunion)+262Romania (România)+40Russia (Россия)+7Rwanda+250Saint Barthélemy+590Saint Helena+290Saint Kitts and Nevis+1Saint Lucia+1Saint Martin (Saint-Martin (partie française))+590Saint Pierre and Miquelon (Saint-Pierre-et-Miquelon)+508Saint Vincent and the Grenadines+1Samoa+685San Marino+378São Tomé and Príncipe (São Tomé e Príncipe)+239Saudi Arabia (المملكة العربية السعودية)+966Senegal (Sénégal)+221Serbia (Србија)+381Seychelles+248Sierra Leone+232Singapore+65Sint Maarten+1Slovakia (Slovensko)+421Slovenia (Slovenija)+386Solomon Islands+677Somalia (Soomaaliya)+252South Africa+27South Korea (대한민국)+82South Sudan (جنوب السودان)+211Spain (España)+34Sri Lanka (ශ්රී ලංකාව)+94Sudan (السودان)+249Suriname+597Svalbard and Jan Mayen+47Sweden (Sverige)+46Switzerland (Schweiz)+41Syria (سوريا)+963Taiwan (台灣)+886Tajikistan+992Tanzania+255Thailand (ไทย)+66Timor-Leste+670Togo+228Tokelau+690Tonga+676Trinidad and Tobago+1Tunisia (تونس)+216Turkey (Türkiye)+90Turkmenistan+993Turks and Caicos Islands+1Tuvalu+688U.S. Virgin Islands+1Uganda+256Ukraine (Україна)+380United Arab Emirates (الإمارات العربية المتحدة)+971United Kingdom+44United States+1Uruguay+598Uzbekistan (Oʻzbekiston)+998Vanuatu+678Vatican City (Città del Vaticano)+39Venezuela+58Vietnam (Việt Nam)+84Wallis and Futuna (Wallis-et-Futuna)+681Western Sahara (الصحراء الغربية)+212Yemen (اليمن)+967Zambia+260Zimbabwe+263Åland Islands+358 Invalid phone number I give permission to receive EOPS related text messages at the above cell phone number Yes No Demographics Date of Birth Age Ethnic Background Ethnic Background - Select -American IndianAsianBlackFilipinoHispanic/ChicanoPacific IslanderWhite/AngloOther… Enter other… Marital Status - Select -SingleMarriedDivorcedSeparated Previous Year Total Family Income Please check all that apply to you Documentation will be needed to determine eligibility for EOPS I am enrolled or plan to enroll full time (12+units) at Ventura College I do not qualify for intermediate algebra (Math 3) or higher by testing I did 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Yes No Place of Birth To assist you in your admission to the college: Are you a U.S. citizen? Yes No You have indicated that you are not a U.S. citizen. Do you or your parents have an alien registration/temporary resident/amnesty card or other INS documents? Yes No CalWORKs CalWORKs students must complete this section. (Only complete this section if YOU, the student, are a CalWORKs recipient receiving Cash Aid. This does not include those whose family members are receiving cash aid through CalWORKs.) I currently Receive TANF/CalWORKs I am a single parent Family Size # of children under 18 Photo Release I give permission to EOPS to take and use photos / videos of me in publications and in any other communications related to EOPS Yes No Signature I certify that the above statements are true and I will supply any documents needed to determine eligibility, and I give permission to review high school and/or college records Enter Your Full Name How did you hear about EOPS? 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