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ЖЖЖ┐Visualize the PossibilitiesFreestyle Scriptc"ё$   ┐   ?  Ё▐ОHv:Ё h0ЁЮв Ё C ЁА┐ ┐s"ё*@@   ┐   ?  Ё└EC:Ё h1: Ё  Ё4в Ё  Ё`АБрОВрОГрОДрОБГ┐└┬ ДрОЕрОЖрОЗрО#"ёlН└@@ @@@BАВ┐└┬ ?@B :Ё xн╦  Ъ┼╥  ИR4 ё3I:Ё h2: Ё  Ё4в Ё  Ё`АБрОВрОГрОДрОБГ┐└┬ ДрОЕрОЖрОЗрО#"ёlН└@@ @@@BАВ┐└┬ ?@B :Ё xн╦  ф■╟  ИR4 p*╧ :Ё h': Ё  ■      ┌Ў╚ЭЦ╤О└O╢■╬Quill96 Story Group Class    Ї9▓qБВГД■                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               CHNKINK )Z°VTEXTTEXTSTSHSTSHSTSHSTSH ^STSHSTSH~<FDPPFDPPFDPPFDPPFDPPFDPPFDPPFDPPFDPPFDPPFDPCFDPC FDPCFDPC"FDPCFDPC$FDPCFDPC&FDPCFDPC(FDPCFDPC*FDPCFDPC,FDPCFDPC.FDPCFDPC0FDPC FDPC2EOPS Update Information Form Fall (year)____________________ EOPS First Name: ________________________________ Last Name: ___________________________________________ Address: ________________________________________________ Primary Phone #: _______________________ City & Zip Code: __________________________________________ Other Phone #: _________________________ Birthdate: _________________ SID: ________________________ SSN: __________________________________ Is the above a new address or phone number? r Yes r No What is/will be your enrollment status? r Full-time (12 or more units) r 3/4 Time (9-11.5 units) р a Waiver of 12 Units form must be completed r Half-time (1-8.5 units) р a Waiver of 12 Units form must be completed Do you have any physical or learning disabilities for which you could use assistance? r No r Yes Have you been certified to receive services from the Disabled Resource Center? r No r Yes r Don t know what DRC is Are you/your family currently receiving TANF/CalWORKs cash aid? r No r Yes Marital Status: r Single (Never Married) living w/parent(s) r Single (Never Married) not living w/parent(s) r Married living with spouse r Married (Separated) not living with spouse r Divorced r Widowed r Living with significant other (boyfriend/girlfriend) r Single Parent (Do not check this box if you are living with your child s parent or a boyfriend/ т girlfriend) т If Single Parent, do you have a dependent child who is under 14 years old and living with you? r Yes r No If yes, list name(s) and birthdate(s): ___________________________________________________ _________________________________________________________________________________ What is your major or field of study? ____________________________________ What is your goal at Mendocino College? r AA/AS degree r Transfer to a 4-year university r Certificate т r Undecided If transferring, what university are you interested in attending? _____________________________________________ Signature ___________________________________________________________ Date ______________________ Continuing EOPS students should complete this form and return it to: Mendocino College ╖ EOPS Office ╖ 1000 Hensley Creek Road ╖ Ukiah CA 95482 ╖ Phone 468-3113 ╖ FAX 468-3197 aNт1·а    JаNт1·а>Ъ2 "Ё$КИИИИИИИИ И И И И ИИИ И И ИИ И ИИИ ИИ,И9"ЁDК "HК "Я01(█Nт1·а    С|    С|bove a new address or phone number? :<|~АКRтик▓№№╨╨№№╚ЬММ,№╘и, "Г№  "°|2В'(КИ ░с",2В&'(КИ ТИ А╧7,2В&'(КИ ШX-И А╧7`"2ВN'(КDИ ■╞И j%И а█)И /И 8ЗmЗ4"bО "4"bО ,"2В'(КИ /4"bО  ,2В&'(КИ кЧ И ╨э ▓D╓▐авX Ф Ц , . ╢╢Рj,jj ╝rJ"2В>'(К4И $(И А╧7И фDИ ▄БGP "Г№  "°|2В>'(К4И $(И xL;И фDИ ▄БG 2В'(КИ └ч>"2В2'(К(И ╚jИ ░с"И М`,&"2В'(КИ ШX-&"2В'(КИ ░с"J"2В>'(К4И ░с"И Ї =И P╜LИ 84W .  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