INSTRUCTIONS TO COMPLETE THE H.E.P. APPLICATION

Transcription

1 INSTRUCTIONS TO COMPLETE THE H.E.P. APPLICATION You need to submit the following information with your application as soon as possible in order to be considered for acceptance to the H.E.P. program: 1. Your autobiography, 3 pages minimum. Write about your past, your present, and your future goals in your own handwriting. 2. Photocopies of at least 2 pieces of identification, such as state driver's license or identification card, US immigration card, US passport, social security card, US temporary work card, voter's registration card, or birth certificate. If outside the USA, you can also add a copy of identification, birth certificate, and other documents. 3. Transcripts or records from the last school attended. 4. Two letters of recommendation (detailed) from people who know you well, (i.e. teachers, counselors, employers, etc.). We will not accept letters of recommendation from family members. 5. The Employment History Verification Form attached, must be signed by your employer. You may also submit a letter from your employer or copies of check stubs. The information must show that your past work experience or your parents' fulfill the requirements to qualify for H.E.P. (see requirements to qualify for H.E.P. on the next page.) 6. A recent photograph. 7. If you have been on probation, received treatment for drugs or alcohol, or have current health problems, we need reports from your probation officer, doctor, or counselor. 8. Please fill up all blank spaces. We will not accept incomplete applications. 9. Hand deliver or mail the application to: H.E.P E 17th Avenue, Eugene OR

2 If you have any question please call the secretary (541) or the recruiter (541) The High School Equivalency Program is a federally funded program that provides an alternative educational opportunity for men and women 16 years old and older, who have not completed a high school education. H.E.P. has the following goals: a) to provide migrant and seasonal farm working youth with academic skills necessary to pass the G.E.D. exam; b) to provide career counseling information and increase awareness of job opportunities, job training programs, and higher education. H.E.P. offers an educational and cultural experience at the University of Oregon and is administered by the College of Education. H.E.P. is empowerment through education and growth that values community involvement and cultural diversity. The applicant must: REQUIREMENTS TO QUALIFY FOR THE H.E.P. PROGRAM be 16 years old or older. If applicant is 16 or 17 years old, a verification of attendance release form must be completed by the last school attended.) not have completed high school have worked at least 75 days within the last two years in agriculture as a migrant or seasonal farm worker. This includes any activity directly related to the production of crops, dairy products, poultry, livestock, cultivation or harvesting of trees, ranching, fishery, cannery, nursery, and forestry work. * You may also qualify for H.E.P. if your parent(s) or legal guardian(s) meet the work requirement describe above. H.E.P. has a caring and professional staff ready to instruct and help prepare students for the G.E.D exams, and assist in setting future goals. In addition to our academic program, many services are available to the H.E.P. students, such as: housing in the university dormitories if you are selected as a residential student. a weekly stipend (for regular attendance only) study and reference materials to prepare you for the G.E.D. tests academic, social, and vocational counseling and guidance transportation costs to H.E.P. when accepted and back home upon completion or termination of program. recreational, social and cultural activities limited medical services

3 SECTION 1: H.E.P. APPLICATION FOR ADMISSION Name: Age: Sex: Social security number: Date of birth: Marital status: Address: Number Street City State Zip code Telephone number: ( ) Message number: ( ) Are you US citizen? Yes ( ) No ( ) Temporary resident? Yes ( ) No ( ) Permanent resident? Yes ( ) No ( ) Card number: SECTION 2: Do you have a G.E.D. or high school diploma? Yes ( ) No ( ) Have you taken any G.E.D. tests? Yes ( ) No ( ) If yes, where and when? Were was the last school you attended in USA or any other country?

4 How long? What grade level? Reason for leaving school? Do you read the newspaper in English? Yes ( ) No ( ) Language spoken at home? Name of person to contact in case of an emergency: Name Relationship Address City State Zip Code ( ) ( ) Phone number Work phone number Ethnic Background: European American ( ) Native American ( ) African American ( ) Asian American ( ) Hispanic/Latino ( ) SECTION 3: Who referred you to H.E.P.? ( ) Name Phone number Have you ever been convicted of a crime? Yes ( ) No ( ) If yes, please explain: Are you on parole or probation? Yes ( ) No ( ) If yes, probation officer s name and phone number: SECTION 4:

5 Physical handicap? Yes ( ) No ( ) If yes, please explain: Do you smoke? Yes ( ) No ( ) Do you have a problem with alcohol or drugs? Yes ( ) No ( ) If yes, have you ever been treated or received treatment for having consumed or used alcohol and/or other drugs? Yes ( ) No ( ) Place Counselor s name Approximate dates when you received treatment Did you complete the program? (yes or no) Describe any allergies, health problems, or recent operations of which H.E.P. should be aware: SECTION 5: What are your plans after you received your G.E.D. and leave H.E.P.? What are your career goals? Apply to a vocational school or program? Yes ( ) No ( ) Name of vocational school or program: Vocation you plan to study: Apply to a two year community college? Yes ( ) No ( ) Name of community college: Course of study: Apply to a four-year college/university? Yes ( ) No ( )

6 Name of college/university: Course of study: SECTION 6: I hereby certify that I, fully answered all questions to the best of my knowledge. I understand that giving false answers could result in my termination from participation in this program. Signature of applicant Date Signature of parent or legal guardian (if applicant is under 18 years old) Date SECTION 7: For office use only:

7 FOR STUDENTS 18 YEARS OLD AND UNDER PARENTAL CONSENT FORM

8 I hereby give permission for my son/daughter to attend the University of Oregon s High School Equivalency Program. In case of emergency, I give my permission for my son/daughter to be treated by available medical personnel. Parent s signature (legal guardian)