Family. CalWORKs. Opportunity. Making the Connection

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1 Family CalWORKs Opportunity Making the Connection

2 CalWORKs CalWORKs (California Work Opportunities and Responsibility to Kids) is a plan developed in response to the Federal TANF (Temporary Aid to Needy Families) Program. The Barstow Community College CalWORKs Program focuses on creating opportunities for students to obtain and/or enhance the marketable skills they need to make a smooth transition from receiving cash aid to long term employment. CalWORKs students receive education and employment training, support services, work study opportunities and funding for child care. A counselor is also available to assist students in developing an educational and employment plan that addresses both short term and long-term goals. Together Barstow Community College and CalWORKs lead students toward a path to self-sufficiency by increasing students wage earning power. Benefits of CalWORKs While assisting students to achieve their educational goal, CalWORKs provides support services which include but are not limited to: Assistance in meeting the 32/35 hours per week activity requirement Work-study opportunities Funding for Child Care Career Assessments and planning as well as interviewing preparation Providing school supplies )notebooks, pens, pencils, scantrons, paper, calculators, dictionaries, and other supplies needed for class) Peer advisement Academic and personal counseling. How do I qualify? To qualify for the CalWORKs Program, a student must meet the following requirements listed below: Be a resident of California Be a CalWORKs participant with the county and be receiving CalWORKs/cash aid assistance for self and the children OR for self only (not just the children) Be enrolled in at least 6 units at Barstow Community College Steps to Applying 1. Complete a Barstow Community College Admissions Application: Barstow Community College s Admissions application can be completed online at or For assistance in completing the application, come by the CalWORKs or Admissions Office for help. 2. Take the Accuplacer Assessment Test: Contact the Barstow Community College Testing Office at (760) ext to schedule an appointment or to confirm testing hours. On an exam day, every student must bring with them a valid picture ID and pen/pencil for the exam. 3. Apply for Financial Aid: Complete and submit the Free Application for Federal Student Aid (FAFSA). The FAFSA can be competed online at For assistance in completing the application, come by the Financial Aid Office for help. 4. Submit a Completed CalWORKs Packet: The entire CalWORKs packet is available online at calworks or it can also be obtained by visiting the CalWORKs Office. A completed packet will contain the following materials: CalWORKs Application Contractual Agreement Form Release of Information Form Proof of CalWORKs/cash aid (current notice of action attained from your eligibility worker) Current Class Schedule Welfare to Work Plan (obtained from your eligibility worker) Resume Work Availability Worksheet How to Contact CalWORKs Director of Special Programs and Services: (760) ext EOPS Program Specialist: (760) ext

3 CalWORKs Application Student ID Term: Fall Spring Summer First Name Middle Last Name of Birth Address City State Zip Home Phone Cell/Message Phone Are you a California Resident? Yes No If yes, how long have you lived in California? Have you applied for: (check all that apply) Financial Aid EOPS CARE DSPS Educational History Did you receive a high school diploma? Yes No GED? Yes No Are you currently enrolled at Barstow Community College? Yes No How many units are you enrolled in? Have you ever attended another college or technical school before? Yes No If yes, please list the name and location of each school below: Did you receive a degree/certificate? Case Information Case Number: Yes Yes No No CalWORKs/TANF Case Worker: Employment Specialist: Phone: Phone:

4 Marital Status Family Single Married Married, but Separated Divorced Widowed How many children do you have? Please list all children and provide information below: Child s Name of Birth Gender Did they receive separate aid? If you need more space to complete, attach a separate sheet. Support Services Please indicate which services you will need assistance with: Transportation Textbooks Other personal services located off campus Child Care Personal/academic counseling Employment Services Please attach a current resume. Include your past five (5) years of employment history. Do you have reliable transportation to and from school and work? Yes No All applicants read this statement and sign below: I hereby swear or affirm, under penalty of perjury, that all information provided on this form is true and complete to the best of my knowledge. If asked by an authorized official, I agree to give proof, which may include a copy of my and/or my children s public assistance award documents. I also realize that any false statement or failure to give proof when asked may be cause for denial, termination, and/or repayment of CalWORKs services. I authorize the sharing of information regarding this application between Barstow Community College, the college district, and the Chancellor s Office of the California Community Colleges. Applicant Signature :

5 CalWORKs Contractual Agreement Name: B Number: As a participant enrolled in the Barstow College CalWORKs Program, I agree to the following: Provide a Notice of Action form (proof of TANF) each semester to verify eligibility for aid and immediately report with written verification any changes in aid allotment. Provide a schedule/proof of registration each semester and notify CalWORKs of any changes in my schedule. Be involved in (as required) hours per week of work-related activities. Develop a student educational plan. Complete each class with a C grade or better. Meet with my CalWORKs case manager/counselor two times each semester or as requested. Attend two workshops each semester. Adhere to child care requirements (if applicable) Notify CalWORKs and my employer of any changes in my address and phone number. Appear at all arranged job interviews. Show up for work on time, fulfill my job requirements, and notify my employer whenever I must be absent or late. Complete assignments, projects, examinations, and finals. I acknowledge that my objective upon entering the Barstow College CalWORKs program is to complete training and to acquire the skills necessary to becoming employed. I fully understand the terms, rights, and obligations stated in this contract. I will be responsible for complying with these program requirements. I understand that failure to do so will result in termination from the program and all applicable service. Participant s Signature CalWORKs Manager s Signature

6 CalWORKs Release of Information Name: B Number: This authorizes the Barstow College CalWORKs staff to consult with my Case Worker, TANF Eligibility Worker and Employment Specialist in order to discuss or release past or current information as it pertains to the following aspects of and/or about my case: School Records/Transcript Information Employment Information CalWORKs/WDC Case Management Information Job Placement ΤΑΝF Verification Financial Aid Information Child Care Information This release shall remain in effect during the entire duration of my enrollment or until revoked in writing. Participant s Signature Signature of Parent or Guardian Required for students under 18 years of age

7 CalWORKs WORK AVAILABILTY WORKSHEET Name: B Number: Semester/Year: Shade the times that you are NOT AVAILABLE to work 7:00 AM 8:00 AM 9:00 AM 10:00 AM 11:00 AM 12:00 PM 1:00 PM 2:00 PM 3:00 PM 4:00 PM 5:00 PM 6:00 PM 7:00 PM Monday Tuesday Wednesday Thursday Friday Saturday Sunday

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