Students interested in the Adult Reentry Student Alliance are encouraged to complete this brief interest survey. This form will help us understand your needs better to provide the services you can benefit from. It will also grant you access to the Adult Reentry Student Alliance Canvas Shell which is an additional resource for adult reentry students. Once you submit this form, you may expect to receive a welcome email with more information within 1-2 weeks. First Name Last Name COC Student ID Number Telephone Number COC Canyons Email Alternative Email When was your first semester returning to COC? What are your goals at COC? Earn a Certificate Earn an AA/AS/AA-T/AS-T degree Transfer to a University Professional Development Job Enhancement Skills Undecided Other Are you a part time student (enrolled in less than 12 units)? Yes No Are you a full time student (enrolled in 12 + units)? Yes No Are you a parent? Yes No If yes, are your children 18 and under? Yes No What resources or services on campus would you benefit from? Counseling (Academic, Career and Personal) Mental Health Counseling Tutoring Financial Aid Career Services Academic Accommodations Center (formerly known as DSPS) Workshops for Previously Incarcerated Students Parent Student Workshops Mentoring Clubs & Organizations Other What is the best way to contact you? Email Social media Snail mail Other Additional comments, questions, and/or concerns? Leave this field blank