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INDEPENDENT SCHOLARS PROGRAM
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ACADEMIC STANDINGS
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HIGH SCHOOL INFORMATION
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Independent Scholars

Independent Scholars Specialized Counseling Services
INTEREST FORM


Thank you for your interest in the Independent Scholars Specialized Counseling Services.
Your information will be kept for future reference. You will be contacted by our office to give
you further information on the Independent Scholars services available.

For Information, call: 909-652-6504
E-mail: ischolars@chaffey.edu


   

Date Form Submitted
*
   
  Contact Information

First Name
*
  Last Name
*
  Street Address
*
  City
*
  State
*
  Zip
*
  Phone/Extension
*
  E-Mail Address
*
  Student ID Number
*
   
  Background Information
Please select "yes" or "No" as it applies:
  Are you currently in the EOPS program?
Yes  No *
  Have you submitted acceptable forms of documentation to BOTH Financial Aid and EOPS?
Yes  No *
  ACCEPTABLE FORMS OF DOCUMENTATION ARE:
  • Transitional Independent Living Plan (TILP) with your formal name.
  • Court reports indicating your status as a ward of the court.
  • Any document from the Department of Social Services Independent Living program with your formal name.
Your ILP Coordinator, your After Care Services Worker, your former Social Worker or The California Department of Social Services can verify your foster youth eligibility status.
   
 
  * Entry required in this field
   
 
   






Rev. 9/13/16


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