Enrollment Information

Term Intersession & Spring 2020

Educational Goal Improve basic skills

Major/Program area of study Business Administration, AA

Account Information

OpenCCC Account

Name Akshat Mahendra

Permanent Address 2383 Davis Avenue

Conaway Street Williams
california, CA 91505

Previous Name

Preferred Name

Main Phone (810) 746-7195

Ext:

Second Phone (810) 756-7890

Ext:

Email mahendra.akshat@hotmail.com

Social Security Number ***-**-****

Date of Birth February 9, 1996

Mailing Address

Same as My Account Yes

Education

Enrollment Status as of 01/05/2020 First-time student in college (after leaving high school)

High School Education Level as of Not a graduate of, and no longer enrolled in high school

Neither Received a diploma or certificate of completion in California

Neither Attended high school in California for three or more years

Grade Point Average

Highest English Course Taken

Highest English Course Grade

Highest Math Course Taken

Highest Math Taken Grade

Citizenship/Military

Citizenship Status U.S. Citizen

Military Status as of 01/05/2020 None apply to me

Residency
Yes Lived in California Continuously since 01/05/2018

No Since 01/05/2018 declared residency in another state for state income tax purposes

No Since 01/05/2018 voted or registered to vote in another state

No Since 01/05/2018 declared residency at an out-of-state college or university

No Since 01/05/2018 petitioned for a lawsuit or a divorce as a resident in another state

No At any time in the last 24 months have you been determined to be homeless?

No Have you ever been in court-ordered foster care?

Needs and Interests

Yes Comfortable reading and writing English

No Would like information about money for college

No Receive TANF/CalWORKs, SSI, or General Assistance

Programs and services in which you are interested

No Academic Counseling/Advising

No Athletics/Intercollegiate Sports

Yes Basic Skills (reading, writing, math)

No CalWorks

No Career Planning

No Child Care

No Counseling - Personal

No DSPS - Disabled Student Programs and Services

No EOPS - Extended Opportunity Programs and Services

No ESL - English as a Second Language

No Health Services

No Housing Information

No Employment Assistance

No Online Classes

No Re-entry Program (after 5 years out)

No Scholarship Information

No Student Government

No Testing, Assessment, Orientation

No Transfer Services

No Tutoring Services

No Veterans Services

Demographic Information

Gender Male
Parent/Guardian Education Levels 1: Grade 9 or less
2: Some high school; did not graduate

Hispanic/Latino No

Race
White
Canadian

Supplemental Questions

Student Survey Information (optional)

Yes 1. Are you a dependent of your parents? You are a dependent of your parents if they claimed you on
their income tax last year.

No 4. Are you currently receiving benefits from TANF/Cal WORKS?

No 5. Are you currently receiving benefits from Supplemental Security Income (SSI)?

No 6. Are you currently receiving benefits from General Assistance (GA)?

No 7. Do you plan to apply for Extended Opportunity Programs '&' Services (EOPS)?

No 8. Are you currently receiving benefits from Financial Aid (Pell Grant, BOGG, or other)?

No 9. Are you currently receiving benefits from Section 8 Housing Assistance?

No 10. Are you currently receiving benefits from any other form of public assistance?

No 11. Do you plan to apply to the Disabilities Support Program (DSP)?

No 12. Are you a single parent with custody of one or more minor children?

No 13. Are you a displaced homemaker attending College to develop job skills?

No 14. Do you receive or need assistance in English because English is not your first language?

2. How many family members are living in 2

your household (including yourself)? If you
live with your parents, count you, your
parents, and all other dependents they
support. If you are self-supporting, include
yourself, your spouse, and any dependents.

3. Check your family household's taxable $0 - $9,000

income (not total income). If you were
claimed on a parent's federal tax return, add
your income to theirs. Married? Add your
spouse's income to yours. Single and
self-supporting? Use only your taxable
income.

Adult Education School

No Have you attended an Adult Education School?

If Yes, please enter the High School Name.

If Yes, Please enter the date last attended.