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TPP Enrollment Form 1-09

The document is an application for the Transfer Partnerships Program at University of California, Santa Cruz. It requests basic contact and demographic information from applicants such as name, address, phone number, student ID, ethnicity, community college attended, majors and careers of interest, anticipated transfer date, and languages spoken at home. It also asks about parents' highest level of education and if the applicant qualifies for additional support as a former foster youth or homeless individual. Applicants sign to authorize sharing of academic information and use of their name/image for promotional purposes.

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46 views4 pages

TPP Enrollment Form 1-09

The document is an application for the Transfer Partnerships Program at University of California, Santa Cruz. It requests basic contact and demographic information from applicants such as name, address, phone number, student ID, ethnicity, community college attended, majors and careers of interest, anticipated transfer date, and languages spoken at home. It also asks about parents' highest level of education and if the applicant qualifies for additional support as a former foster youth or homeless individual. Applicants sign to authorize sharing of academic information and use of their name/image for promotional purposes.

Uploaded by

uctpp
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Transfer

University of California, Santa Cruz


Partnerships 1101 Pacific Ave, Suite 210
Program Santa Cruz, CA 95060
http://epc.ucsc.edu
A Bridge to Your Future
(831) 459-1790

Last Name (Please Print Clearly) First Name Middle Initial Today’s Date

Mailing Address City State Zip Code


( ) Female
Telephone Number Date of Birth Male E-Mail (Please Print Clearly)

Student ID Number Social Security Number (optional)


I authorize institutions at which I am/was enrolled to share academic and other information with the University of California for the
purposes of advising and program participation. I permit my name, photograph, and quotes to be used for program promotional
purposes.

Signature Date
Major interest / career objective:
Community College presently attending (or last attended)

Colleges previously attended


High School Year graduated
College Level (Check one): UC campuses of interest:
Freshman (less than 30 semester / 45 quarter units) Berkeley
Sophomore (more than 30 semester / 45 quarter units) Los
Angeles
Anticipated Transfer Date (Check one and indicate year) Merced
Fall
Year
Davis
Santa
Cruz
Riverside

Irvine
Santa
Barbara
San
Diego
Winter

CSU/Independent colleges of interest:

__________________________
Ethnicity:
African American / Black
Chinese/Chinese American
Japanese / Japanese American
Other

Pacific Islander
White / Caucasian
Other Spanish American / Latino
Declined to state / Don’t Know

American Indian/Alaska Native


Filipino / Filipino American
Korean / Korean American

Vietnamese/Vietnamese American
Other Asian
Mexican / Mexican American
Program Affiliation (Check all that apply): Parent’s Highest Level of Education (Check all that apply)
Advancement Via Individual Determination (AVID) Father
Disabled Students Programs and Services (DSPS) Mother
Early Academic Outreach Program (EAOP)
Extended Opportunity Programs and Services(EOPS) No High School Diploma
Mathematics Engineering Science Achievement (MESA) No High School Diploma
Puente Program
Re-Entry Services
High School Diploma
Transfer Center
High School Diploma
TRIO Student Support Services
Upward Bound
Other (specify): Some 4-Year College
Some 4-Year College

University Degree
University Degree

Language Spoken at Home (Check all that apply)


English
Asian
language
group

Spanish
Other
non-English

Former Foster Youth, Homeless, Wards of the Court and/or Orphans: if you are
interested in support and services to help you go to college, check here
MG 2/09

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