CSULB,College Assistance Migrant Program (C.A.M.P.)Application

All information will be kept confidential & used only for determining your eligibility to the program

Full Name (Preferred name if other then legal name)

Address: City: State: Zip Code:

Home Phone Number:Cell/Message Number:

Male/FemaleE-Mail Address/es

Date of Birth: Social Security Number:

City, State & Country of citizenship (place of birth):

If you are not a U.S. citizen, are you a permanent resident? YESNO

Alien # (only if applicable):

Name of High School(s) City & State Graduation Date:

Test scores: ACTSAT N/AELMEPT

What is your intended major/s at CSULB?

Ethnicity (Please list all that apply to you) IE: Latino/a, African-American, Asian, Pacific Islander, Euro-American, Other, etc.

How did you hear about CAMP?

CAMPEligibility Information:

To be eligible to participate in CAMP, either the student or immediate family member must be a seasonal or migrant farm worker or a dependent of a seasonal or migrant farm worker. “Seasonal farm worker” means a person who was employed in farm work and whose primary employment was in farm work on a temporary or seasonal basis (not a constant year-round activity).“Migrant farm worker” means a person whose employment required travel that prevented him or her from returning home within the same day.

In addition, you must have a high school diploma or a G.E.D., and you must be enrolled as a full-time student at CSULB. California residency with U.S. citizenship or legal permanent resident status is also required.

You or any member of your immediate family performed agricultural or farmwork for 75 days or more within the last 2 years ORyour family is currently in the Migrant Education Program.

AgriculturalActivity:
-Working in any activity directly related to the production of crops, dairy products, poultry, or livestock
-Any activity related to the cultivation or harvesting of trees
-Any activity directly related to fish farms
Farmwork:
-Any agricultural activity, performed for either wages or personal subsistence, on a farm, ranch, or similar establishment

Name of Family member(s) that worked:Relationship tostudent applicant:

List the most recent and accurate information

Start Date / End Date / Type of Work Performed / Name and address of Employer
(IE: Farm, Ranch, Nursery, etc.)

If you are currently in the Migrant Ed. Program (MEP):

Please list Certificate of Eligibility (COE) number:

I certify that I am eligible for the CSU-Long Beach CAMP and that the above information is complete and accurate according to our records. I further understand that any false statement will subject me to immediate dismissal from the program (Note: If this document is e-mailed, please sign the copy to be filed in the CAMP office).

Print Name Applicant Signature (If you are under 18 years of age, a parent signature is required) Date

You or any member of your immediate family wasever in the federal Migrant Education Program (Pre-Kinder. through High School)OR your family was eligible to participate in the Migrant Education Program because of previous Agricultural activity or farmwork. Answer only one (Section A or B)

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Agricultural Activity:
-Working in any activity directly related to the production of crops, dairy products, poultry, or livestock
-Any activity related to the cultivation or harvesting of trees
-Any activity directly related to fish farms
Farmwork:
-Any agricultural activity, performed for either wages or personal subsistence, on a farm, ranch, or similar establishment

A) I did participate in the Migrant Education Program in (Please list all that apply):

Name of School & Location
Elementary School
Middle School
High School

My Certificate of Eligibility (COE) number is:

B) My family was eligible to, but did not participate in the Migrant Education Program:

Name of eligible Family member(s):Relationship tostudent applicant:

List the most accurate information

Start Date / End Date / Type of Work Performed / Name and address of Employer
(IE: Farm, Ranch, Nursery, etc.)

I certify that I am eligible for the CSU-Long Beach CAMP and that the above information is complete and accurate according to our records. I further understand that any false statement will subject me to immediate dismissal from the program (Note: If this document is e-mailed, please sign the copy to be filed in the CAMP office).

Print Name Applicant Signature (If you are under 18 years of age, a parent signature is required) Date

You or anyone in you immediate familyeverparticipated in the federal programs under the Workforce Investment Act for migrant and seasonal farm workers.

My WIA program case worker’s name is:

I certify that I am eligible for the CSU-Long Beach CAMP and that the above information is complete and accurate according to our records. I further understand that any false statement will subject me to immediate dismissal from the program (Note: If this document is e-mailed, please sign the copy to be filed in the CAMP office).

Print Name Applicant Signature (If you are under 18 years of age, a parent signature is required) Date

CSULB CAMP Important Deadlines:

Note: Currently CSULB CAMP does not have an application deadline. Our only urgency is that you confirm your acceptance to the university prior to us being able to accept you into the College Assistance Migrant Program (CAMP).

  1. CAMP Application Deadline Ongoing/None
  2. CSULB Application Deadline October 1st - November 30th of previous year (H.S. senior yr.)

a.CSULB Intent to Enroll Deadline May 1st

b.CSULB Enrollment Deposit Due May 1st

  1. EOP Application Deadline March 2nd

CSULB CAMP Document Checklist:

Completed Documents / Date Completed
CAMP Application
CSULB Application: Online at CALSTATE.EDU/APPLY
EOP Application: To be considered for EOP you must indicate your interest in the program by checking the appropriate section on the CSU application. Once you have submitted your on-line University application you will be able to fill out the EOP Application on Cal State Apply. Your EOP file will be complete once we have received the completed Applicant Information Form and two Recommendation Forms.
Supporting Eligibility Documents: Completed and signed “CAMP Eligibility Information” (page 2 or 3) of this CAMP application, Certificate of Eligibility (COE), copy of paycheck, copy of tax forms, letter from employer, etc.
Financial Aid FAFSA Application: Online at FAFSA.ED.GOV

Please verify that each applicant has completed all related sections of this application. Due to the competitive acceptance processinto CSULB, the student must confirmtheir acceptance into CSULB, including the “Intent to Enroll” form before they are officially considered to be part of the College Assistance Migrant Program.

CAMP Director’s Approval (Name & Signature) Date