NAME: DISTRICT: CAMP APPLICATION

Transcription

1 NAME: DISTRICT: CAMP APPLICATION Please mail to: Ruby Luis, CAMP Recruiter Center for Migrant Education Phone: Fax: Official Website:

2 APPLICATION FOR ADMISSION Directions: Please print legibly in black or blue ink or type. PERSONAL INFORMATION SSN: - - Date of Birth: / / Age: Name: Last First Middle Mailing Address: Home Phone: ( ) - Cell Phone: ( ) - Address: Family Information Father s Name: Mother s Name: Parent s Address: Home Phone: ( ) - Cell or Work Phone: ( ) - Immediate Family Size: Emergency Contact: Name: Family Income: Relationship: Address: Home Phone: ( ) - Cell or Work Phone: ( ) - School Information: High School Attended/GED: District: Date Graduated: / / GPA: SAT/ACT Score: Expected Major at USF: How many members in your immediate family have attended or are currently attending college? How did you hear about CAMP? AUTOBIOGRAPHY: Please type an essay of no less than 250 words. The essay will include your farm-worker background, future goals, and any other information that you would consider relevant towards your acceptance in the program.

3 CAMP Eligibility To be eligible to participate in the CAMP program a person whether it is the student or the parent must be a seasonal or migrant farm-worker, or dependent of a seasonal or migrant farm-worker. Migrant farm-worker means a farm-worker whose employment required travel that prevented the farm-worker from returning to his or her home within the same day. Seasonal farm-worker means a person who, within the past 24 months was employed for at least 75 days in farm work, and whose primary employment was in farm work on a temporary or seasonal basis (that is not constant year-round activity). In addition you must: 1) Be a high school or GED graduate; 2) Enrolled as a full-time student at the University of South Florida; 3) And not have completed the first year of college. In order to determine your migrant/seasonal farm work status, please answer the following questions: A. I qualify as a (check one) Migrant: Seasonal Farm-worker: B. Family member who meets migrant/seasonal farm-worker criteria: Name: Address: Relationship to applicant: Phone: ( ) - C. Name of Employer for qualifying member listed above: Employer Address: Dates of employment: No. of Mos. Type of work he/she performs. (Explain): D. In order for your application to be considered you also need to attach the following documents: 1. Copy of current and previous year federal income tax return (yours & your parents) 2. W-2 forms showing the employer listed above. *CERTFICATION* I certify that I am eligible for USF s College Assistance Migrant Program and that my family s primary employment has been migrant or seasonal farm work in the last two years or there are documents as proof of my qualifications. If admitted to the program, I also agree to enroll as a full-time student and to follow all program rules and regulations. I further understand that any false statement subjects me to immediate dismissal from the program. Signature If under 18, parent/legal guardian must sign also. Signature Date Date

4 University of South Florida College Assistance Migrant Program Recommendation To the student: Please take this form to a teacher, counselor, school administrator, or employer who knows you. Ask this person to complete the form. Student Name: SS.#: Student Address: Ph:( ) To the Evaluator: This student is applying for admission to the College Assistance Migrant Program (CAMP), at the University of South Florida. Please evaluate the applicant s potential for success in college relative to his/her peers, and mail directly to: University of South Florida CAMP Your answers will be kept in strict confidence. If we can answer any questions, our number is (813) Thank you for your assistance. Evaluator s Name: Title: School/Organization: Ph:( ) Address: How long have you known this student? In what capacity? Highly recommend Recommend Do not recommend Additional Comments: (Feel free to send an attachment) _

5 University of South Florida College Assistance Migrant Program Recommendation To the student: Please take this form to a teacher, counselor, school administrator, or employer who knows you. Ask this person to complete the form. Student Name: SS.#: Student Address: Ph:( ) To the Evaluator: This student is applying for admission to the College Assistance Migrant Program (CAMP), at the University of South Florida. Please evaluate the applicant s potential for success in college relative to his/her peers, and mail directly to: University of South Florida CAMP Your answers will be kept in strict confidence. If we can answer any questions, our number is (813) Thank you for your assistance. Evaluator s Name: Title: School/Organization: Ph:( ) Address: How long have you known this student? In what capacity? Highly recommend Recommend Do not recommend Additional Comments: (Feel free to send an attachment) _