Inspire Scholars Application

Welcome to the College of the Canyons Inspire Scholars Program! Inspire Scholars/NextUp provides a welcoming, safe, and supportive space for current/former foster youth students. We are here to support you in achieving your higher education/career goals.

Completion of this application will assist us in determining your eligibility for Inspire Scholars/NextUp (current/foster youth). Participating in as many programs as possible will maximize your support and resources, ensuring your success at College of the Canyons.

If you have any questions or are at any point confused about this interest form, please email our office with your name and phone number: inspirescholars@canyons.edu. We will reply via email or call you to provide assistance. We look forward to working with you!

COC Student ID

Last Name

(Please enter the name that is used on your School/Legal Records)

First Name

(Please enter the name that is used on your School/Legal Records)

Preferred Name

(Please note that this Preferred Name is not applicable to Admissions and Records processes)

Phone number

(somewhere you can be reliably contacted)

Address

City

State

Zip Code

Do you have a COC email

Yes

COC Email Address

COC requires for all campus communications to occur only with a COC email address. If you don't have one at this time, please enter your personal email for purposes of completing this application.

How do you describe yourself?

Man

Woman

Trans Man

Trans Woman

Non-binary

Genderqueer

Other gender identity

Name of High School attended

City and state of high school attended

What is your high school status?

High School Diploma

G.E.D.

Certificate of Equivalency

High School Proficiency Exam

Certificate of Completion

Foreign High School Graduate

Did not Graduate

Current High School Student

Month and Year of last high school attended

Did you have an Individualized Educational Place (IEP) and/or 504 plan during high school?

Yes

Have you completed AP courses with a possible score of 3 or above?

Yes

For the semester that you’re applying for, have you applied and submitted any of the following applications with the COC Financial Aid office?

Select all that apply

FAFSA (Free Application for Federal Student Aid)

CCPG (California College Promise Grant, formerly known as the BOG tuition fee waiver)

CADAA (California Dream Act Application, for undocumented students who have AB540/ SB68/ AB2000)

None at this time

It is HIGHLY encouraged that you apply for financial aid at College of the Canyons PRIOR TO COMPLETING THIS APPLICATION. Failure to have any type of Financial Aid on file may affect your eligibility for some of our programs. You can apply to either FAFSA, CADAA, OR only the CCPG.

Contact the COC Financial Aid office during business hours via phone, email, or in-person for further assistance.

Have you attended any colleges or universities besides College of the Canyons?

Yes

List all colleges/universities that you have attended and location.

Were you previously enrolled in NextUp at another college?

Yes

If yes to the prior question, what is the name of the college?

What is your educational Goal at College of the Canyons?

Certificate Program Only (No Associate Degree and/or Transfer to University)

Associate Degree only (no transfer to university)

Associate Degree and Transfer to University

Transfer to University only

Noncredit courses (ESL, Citizenship, Career Skills, Business, Counseling, etc.)

Other

What is your major?

(Type out your major, write “undecided” if you are unsure)

What ethnicity group do you identify with?

Native American/American Indian

Asian/Pacific Islander

Black

Caucasian (White)

Hispanic/Latino/Mexican American

Filipino

Multiple Ethnicities

Other

Marital status

Married

Married and head of household (i.e., partner is incarcerated or disabled)

Single

Divorced

Separated

Widowed

Are you receiving cash aid from the county and/or participating in the GAIN program?

Yes

Number of children and their ages in your household

Date of Birth

Were you in foster care at age 13 or above?

Yes

Were you in foster care at age 12 or younger?

Yes

What age are you today?

Please check if you have experienced any of these living situations in the last two years OR while in college

(check all that apply)

In the home of a friend or relative because I lost my housing (examples: fire, flood, lost job, divorce, domestic violence, kicked out by parents, military parent deployment, parent(s) in jail)

In a shelter because I do not have permanent housing (examples: living in a family shelter, domestic violence, shelter, children/youth shelter, FEMA housing)

In transitional housing (housing that is available for a specific length of time only and is partly or completely pain for by a church, a nonprofit organization, or another organization

In a hotel or motel (examples: because of economic hardship, eviction, cannot get deposits for permanent home, flood, fire, etc.)

In a tent, car, van, abandoned building, on the streets, at a campground, in the park, or other unsheltered location

I have not experienced any of the above living situations in the last two years.

Select the option that best describes you:

U.S. Citizen

Permanent Resident/Green Card Holder

Refugee

Visa Holder

Undocumented and/or AB540 student

Unsure

What term/year are you applying for?

By electronically signing this application, I agree to the following:

I certify that the information that I have provided on this application is, to the best of my knowledge, complete and accurate.

I understand that by applying to the Empowerment Programs, I authorize the Empowerment Programs staff to obtain records or data pertinent to my participation from other campus departments and programs.

I understand that completing this application does not immediately result in acceptance.

I give permission to the Empowerment Programs counselors to discuss appropriate academic and personal information with suitable agencies established to help me meet my educational, career, and personal goals.

I consent to have my high school/college records and academic performance reviewed and monitored by the Empowerment Programs counselors as deemed appropriate for my success.

I recognize that submission of an incomplete application and/or falsification will result in my application being denied or withdrawn.

Signature