CALIFORNIA STATE UNIVERSITY, EAST BAY Application Checklist 2011-2012 Please click on the active links within this document to be redirected to the websites and forms listed. ADMISSIONS OFFICE: CSU Undergraduate Application DUE: FEBRUARY 1st 2011 $55 application fee or Request to Waive Admission Application Fee Form Official high school and/or college transcripts SAT I or ACT test scores English Placement Test (EPT) and Entry Level Mathematics Test (ELM) EDUCATIONAL OPPORTUNITY PROGRAM (EOP): (All applicants must qualify and be granted EOP admissions before they can be admitted into the Renaissance Scholars Program) EOP Application DUE MARCH 1st 2011 (Call the EOP office at 510-885-3751 for more information) FINANCIAL AID OFFICE: 2010-2011 Free Application for Federal Student Aid (FAFSA) DUE MARCH 2nd 2011 Make sure CSU East Bay is listed as your first school otherwise, your Cal Grant will not be disbursed here Cal Grant GPA Verification form DUE: MARCH 2nd 2011 Chafee Grant application DUE MARCH 2nd 2011 Copy of 2010 federal income tax return (if applicable) HOUSING OFFICE: CSUEB Pioneer Heights Housing Application (if needed) and $30 non-refundable application fee. SUMMER BRIDGE: (All applicants who are first-time freshmen that are not regularly admissible to the university must qualify for and complete the Summer Bridge Program) Call the EOP office at 510-885-3751 for more information 1 RENAISSANCE SCHOLARS PROGRAM: DUE: APRIL 1st 2011 o 1 - Application o 2 - Personal Statement o 3- Academic Recommendation o 4 - Personal Recommendation o Chafee/ILP Eligibility Form CONTACT INFORMATION: Renaissance Scholars Program California State University, East Bay Student Academic Services, LI-2500 25800 Carlos Bee Blvd. Hayward, CA 94542 Kevin M. Bristow, Coordinator Telephone: (510) 885-4426 E-mail: kevin.bristow@csueastbay.edu Wendy Herbert, Administrative Assistant Telephone: (510) 885-3747 E-mail: wendy.herbert@csueastbay.edu Tempest Jones, Community Outreach Liaison Telephone: (510) 885-4422 E-mail: tempest.jones@csueastbay.edu Fax: (510) 885-3017 Website: www.csueastbay.edu/renaissance APPLICATION AND ALL RELATED DOCUMENTATION MUST BE FAXED, HAND-DELIVERED, OR POST-MARKED BY: APRIL 1st 2011! 2 Application PERSONAL Male Female Name: LAST F I RST Preferred Name: MI DDLE Telephone: Cell/Message: . AREA CO DE / NUMBER AREA CO DE / NUMBER Home Address: NUMBER AND ST REET / APT . NO . CI T Y ST AT E Z I P CO DE ST AT E Z I P CO DE Mailing Address (If different from above): NUMBER AND ST REET / APT . NO . CI T Y E-mail Address: Date of Birth: Net ID: MO NT H/ DAY/ YEAR Enter code for your ethnic group (Optional): 1 – American Indian or Alaskan Native Tribal enrollment or affiliation 7 – Black, non-Hispanic, including African American 14 – Mexican-American, Mexican or Chicano 21 – Other Latino, SpanishOrigin or Hispanic 2 – Cuban 8 – Cambodian 15 – Laotian 22 – Other Asian 3 – Puerto Rican 9 – Chinese 16 – Vietnamese 23 – Other Pacific Islander 4 – Central American 10 – Japanese 17 – Thai 24 – White 5 – South American 11 – Korean 18 – Other Southeast Asian 25 – Other 6 – Guamanian 12 – Hawaiian 19 – Filipino 26 – No response 13 – Asian Indian 20 – Samoan 27 – Decline to State ACADEMICS School currently attending (or from which you graduated): SCHO O L ADDRESS CI T Y ST AT E Date of graduation: Z I P CO DE Cumulative GPA: Have you participated in any of the following educational programs in high school? Please check below: Upward Bound EAOP (UC) Talent Search Independent Living Program (ILP) AVID ESTEP (Early Step to Emancipation Preparation) 1 FOSTER CARE EXPERIENCE County of Origin: Alameda Contra Costa San Francisco Santa Clara Other: Social Worker: Contact #: Independent Living Program (ILP) Coordinator: Contact #: Age entered into the foster care system: Total number of placements to date: Total time spent in foster care: Contact with biological family: Month and year of emancipation: year(s) month(s) At least once a monthly Several times a year At least once a year No contact Biological family member you are most connected with: Name: Relationship: Contact#: Number of schools attended while in foster care: _____ Current medical coverage: Medi-Cal Elementary Private health insurance _____ None Middle school _____ High school Other: Current Living Arrangement: Foster Home Group Home Relative Residential facility Other: Preferred Living Arrangement for 2009-2010 academic year: Dorms Apartment Relative Other: WORK EXPERIENCE Means of future financial support (mark all that apply): Employment Other (including financial aid): List any job you have held during the past three years (begin with the job you hold or held most recently): Position Employer Approximate dates of employment Approximate work hours per week Total earnings between January 1, 2008 and December 31, 2008: $ 2 AWARDS & ACTIVITIES Tell us about your extracurricular interests or activities in high school and/or college. Include any awards or special recognition. Briefly describe how you spend your summer or winter breaks from school. What are some of the things that make you who you are? Favorite book: Favorite keepsake or memento: Favorite song (title/artist): Favorite food: Favorite movie: Favorite place to get away from it all: Favorite TV program: Two adjectives friends would use to describe you: Favorite source of news: Your source of inspiration: Favorite way to relax: The best advice you’ve ever received: I acknowledge the accuracy, honesty, and completeness of the information supplied for this application. Signature: Date: PLEASE POSTMARK, HAND-DELIVER, OR FAX TO US BY: APRIL 1, 2011! Attn: Renaissance Scholars Program CSU, East Bay – Student Academic Services, LI-2500 25800 Carlos Bee Blvd. – Hayward, CA 94542 Fax#: (510) 885-3017 3 Personal Statement APPLICANT Name: LAST Net ID: F I RST MI DDLE Contact Number: The personal statement is an important part of your application to the Renaissance Scholars program. We use your personal statement to learn more about you as an individual—your talents, experiences, achievements, and points of view. Think of the personal statement as your opportunity to introduce yourself to us. What would you like us to know about you that may not be evident from a review of the rest of your application? Please tell us why you have decided to apply to the Renaissance Scholars Program at CSU East Bay. You may want to write about people who have influenced you, experiences that have shaped you, difficulties or obstacles you have overcome, goals and hopes you have for the future, or anything else you consider important. Regardless of what you choose to write about, your personal statement should reflect your own ideas and be written by you alone. Present your ideas in a focused, thoughtful manner and support them with specific examples. Personal statements comprised of lists of qualities or accomplishments are not useful or effective. Please type your personal statement and attach to this form. Use no more than two 8½‖ x 11‖ sheets of white paper. In the top right corner of each page, type or print your name, Net ID, and the words ―Personal Statement‖. I certify that this personal statement is accurate and entirely my own work. I understand that if either of those representations are not correct, the Renaissance Scholars Program reserves the right to reject my application or withdraw my offer of admission to the program. Signature: Date: PLEASE POSTMARK, HAND-DELIVER, OR FAX TO US BY: APRIL 1, 2011! Attn: Renaissance Scholars Program CSU, East Bay – Student Academic Services, LI-2500 25800 Carlos Bee Blvd. – Hayward, CA 94542 Fax#: (510) 885-3017 1 Academic Recommendation APPLICANT Name: LAST Net ID: F I RST MI DDLE Contact #: TEACHER, PRINCIPAL OR GUIDANCE COUNSELOR Please give your candid appraisal of the student’s academic performance, intellectual promise, and personal qualities. If you have written a letter on behalf of this candidate that responds to the sorts of questions we have asked, it is acceptable to check off the general ratings, sign it, and attach the letter. Please understand that your recommendation may be made available for inspection at the student’s request pursuant to the Family Educational Rights and Privacy Act of 1974. RECOMMENDER INFORMATION Name: PLEASE PRI NT Position/School: Contact #: How long have you known the student? In what capacity? Courses taught to this student (if applicable) Grade level taught this student (e.g., 10, 11, 12, college level) Grade earned 1 STUDENT CHARACTERISTICS Outstanding Excellent Good (top few this year) (top 10%) (above average) Academic motivation: Intellectual Creativity: Academic Potential: Critical Thinking: Open-mindedness: Self-confidence: Concern for others: Leadership: Work Ethic: Emotional maturity: Respect accorded by peers: Selflessness: Academic Achievements: Extracurricular/community: Involvement: Character and personal qualities: Overall : This report is based upon: (check more than one if applicable): Personal observation and/or contact with student Average Other counselors’ observations Below Average Teachers’ N/A Records comments 2 GENERAL EVALUATION 1. How would you describe the student’s participation and performance in class? 2. What particular academic strengths or weaknesses stand out for this student? 3. Are there any noteworthy contributions the applicant has made to the school and/or community? 4. Are there any special circumstances in the student’s background that would help us better understand and appreciate his or her academic or extracurricular performance? Signature: Date: PLEASE POSTMARK, HAND-DELIVER, OR FAX TO US BY: APRIL 1, 2011! Attn: Renaissance Scholars Program CSU, East Bay – Student Academic Services, LI-2500 25800 Carlos Bee Blvd. – Hayward, CA 94542 Fax#: (510) 885-3017 3 Personal Recommendation APPLICANT: Name: LAST F I RST Net ID: MI DDLE Contact #: TO THE PERSON WRITING THIS RECOMMENDATION Please complete this form and attach a letter telling us what you can about the applicant that would help us get to know him or her better. References of this sort are most helpful when examples or anecdotal evidence is provided that allows us to better understand why you have described the applicant as you have. Things such as but not limited to: How long you’ve known the applicant and in what capacity Any particular strengths and/or weaknesses Noteworthy interests, abilities, talents and character traits Community, volunteer or extracurricular involvement Please understand that your recommendation may be made available for inspection at the student’s request pursuant to the Family Educational Rights and Privacy Act of 1974. Name: LAST F I RST MI DDLE Position, title, or relationship: Signature: Contact #: Date: PLEASE POSTMARK, HAND-DELIVER, OR FAX TO US BY: APRIL 1, 2011! Attn: Renaissance Scholars Program CSU, East Bay – Student Academic Services, LI-2500 25800 Carlos Bee Blvd. – Hayward, CA 94542 Fax#: (510) 885-3017 1 PRINT FORM California State University, East Bay On Campus Housing Application CLEAR FORM Return this application with a non-refundable $30 application fee (Check or money order payable to CSUEB, cash is not accepted) to: California State University, East Bay Student Housing and Residence Life 1901 Harder Road Hayward, CA 94542-3030 Academic Year 201__ Quarter: q Fall CSUEB Class Level: qFirst-Time Freshmen q Winter qFreshman q Spring qSophomore q Summer qJunior qSenior qGraduate qALP Personal Information __________________________ Net ID ________________________________________________________________________________________ First Middle Last ________________________________________________________________________________________ Street Address ________________________________________________________________________________________ City State/Province Zip/Postal Code ________________________________________________________________________________________ Country q Male q Female ______________________________________________________________ Gender Date of Birth Phone _______________________________________________________________________________________ Email Major For Office Use Only Date/Initial Application Recieved ___________________ Application Fee Paid ___________________ University Admiit ___________________ California Chafee ETV Program – Foster Care Eligibility Certification Form The applicant identified below is applying for the California Chafee Educational and Training Voucher (ETV) Program administered by the California Student Aid Commission (Commission) under contract and guidance from the California Department of Social Services (CDSS). The Chafee ETV Program assists eligible current and former California youth who were/are in foster care with the costs of attending a postsecondary education and training institution. Eligibility: Youth who were/are in a foster care placement at any time under court dependency, between the ages of 16-19 whose 22nd birthday is prior to July 1, of the award year. To determine eligibility, specific information is required from either a *County authorized Independent Living Program (ILP) Coordinator or Social Worker or Probation Officer (PO). Section I: To Be Completed by Student Applicant (Please Print Clearly or Type) Instructions to applicant: Complete the following information. Make sure you provide your correct social security number (SSN) and Date of Birth (DOB). Sign and forward the form to the authorized *County representative, as listed above. Print Full Name: ________________________________ (First) SSN: ___________________________ (Middle Initial) (Last) Date of Birth: Current Mailing Address: Current Phone Number: (_____) Email:___________________________________ I hereby authorize the appropriate *County representative to complete and release the information listed in Section II of this form that verifies my eligibility to participate in the Chafee ETV Program. [Website for the listing of authorized *County representatives is www.childsworld.ca.gov/ILPCountyC_1443.htm. Applicant’s Signature: Date: Section II: To Be Completed by County ILP Coordinator/Social Worker/PO Instructions to County representative: Complete the following information to certify foster care placement, under court dependency, was established for the youth listed above between their 16th – 19th birthday. State ID Number: County Jurisdiction: Date(s) in foster care placement: By my signature, I certify that the above applicant meets the criteria for the California Chafee ETV Program. Authorized County Representative Signature: Date: Authorized County Representative: County: (Print Name) Phone Number: (____) Email: Please send form to: CDSS - Foster Care Support Services Bureau Independent Living Program Policy 744 P Street, MS 14-78 Sacramento, CA 95814 Fax: (916) 657-4357 Section III: To Be Completed by California Department of Social Services (state representative) I certify that the youth meets the criteria for participation in the California Chafee ETV Program. Authorized State Representative Signature: GZ0002 (07/09) Date: Print Form Cal Grant GPA Verification Form For 2011-12 Academic Year DO NOT SEND ACADEMIC TRANSCRIPTS TO BE FILLED OUT BY STUDENT Please print clearly using blue or black ink only. 1. DEADLINE: MARCH 2, 2011 (POSTMARKED) ( SEE BACK OF FORM FOR INSTRUCTIONS) Your Social Security number: 2. Month/year of high school graduation (If currrently a HS senior, anticipated date) Re-enter your Social Security number: (REQUIRED) 3. Your name — last, first, middle initial, as it is listed on your Social Security card and FAFSA: Your Last Name 4. Your First Name Your date of birth: 5. Telephone number: Month 6. M.I. Day Year Area Code Phone Number Your permanent mailing address: Number and Street City State 7. Your e-mail address, if available: 8. Spring school code: If enrolled for spring 2011, enter your school code. 9. Zip Code CSAC USE ONLY Fill in bubble if you are submitting a SAT, ACT or GED test score instead of a GPA. Attach your applicable test score to this form, transcripts will not be accepted. You do not have to have your school fill out the FOR SCHOOL USE ONLY section 10. STUDENT CERTIFICATION: I have read the instructions and information accompanying this form. I understand that this Cal Grant GPA Verification Form is used to determine Cal Grant eligibility and the GPA must be calculated as described on the attached GPA Calculation Instruction sheet. The information I have completed is true to the best of my knowledge, and I understand that it is illegal to report false or misleading information. I understand that without a valid Social Security number and signature, this form will not be considered. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. _____________________________________________________________ ________________________________________ Student Signature Date FOR SCHOOL USE ONLY (High schools MUST be fully accredited by the Western Association of Schools and Colleges [WASC] or an equivalent regional accreditation agency to certify a Cal Grant high school GPA) GPA IS BASED ON HIGH SCHOOL COURSEWORK? GPA VERIFIER’S SCHOOL CODE: REGIONAL ACCREDITATION AGENCY (HS ONLY) __________________ CALIFORNIA COMMUNITY COLLEGE REESTABLISHED GPA? VERIFIED STUDENT GPA: GPA CANNOT BE ABOVE 4.00 . The signature of the high school or college official certifies, under penalty of perjury, that the GPA is calculated as described on the attached GPA Calculation Instruction sheet. The signature of a high school official also certifies that his or her high school is fully accredited by the WASC or other regional accrediting agency, or has a UC-approved course list as required by California regulations. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. _____________________________________________________________ ________________________________________________ Signature of School Official Name of School _____________________________________________________________ ________________________________________________ Title of School Official Street Address of School _____________________________________________________________ ________________________________________________ Date City E-mail Address State Zip Code Mail completed form to: California Student Aid Commission, Cal Grant Operations, P.O. Box 419077, Rancho Cordova, CA 95741-9077 Instructions for filling out the Cal Grant GPA Verification Form STUDENT INFORMATION SECTION. Please print clearly using blue or black ink only. Filing deadline for 2011-12 awards is March 2, 2011 1. Your Social Security number: Enter your Social Security number (SSN) as it appears on your Social Security card and your FAFSA. (Valid SSNs do not begin with 8, 9 or 000. If you believe your SSN begins with an 8, 9 or 000, then contact your local Social Security Office to verify your number.) Individual Tax Identification Numbers (ITIN) are not accepted. 2. Month/year of high school graduation: Enter the month and year you graduated, or plan to graduate from high school. Enter the month in a two-digit format (for example: January should be appear as “01”; November should appear as “11”). Enter the year in a four-digit format (for example: 2011 should appear as “2011”). 3. Your name: Print your full name as it appears on your Social Security card. Enter last name, first name, middle initial. 4. Your date of birth: Enter your birth date. For example, June 25, 1993 would be entered as 06-25-1993. 5. Telephone number: Enter your area code and daytime telephone number. 6. Your permanent mailing address: Enter your permanent mailing address, city, state and five-digit zip code. 7. Your E-mail address: Enter a “safe” e-mail address where you can be contacted for questions. This is optional. 8. Spring school code: Enter the school code for the school at which you were in attendance for spring 2011. Students graduating from high school in spring 2011 should write in the College Board high school code number for their high school. This is the same code used for sending SAT score information to the high school. Students who will be in college for the spring 2011 school term should write in the federal code number of the college you are attending in spring 2011. Students who are not in college or high school for the spring 2011 school term should leave this section blank. 9. Submitting a test score instead of a GPA: Complete questions 1 through 10, sign the form and attach a photo copy of the testing organization’s score report and mail by the deadline to Commission. TRANSCRIPTS and DIPLOMAS WILL NOT BE PROCESSED. The results from the GED, SAT or ACT tests must be submitted in lieu of a GPA if: You participated in a home schooling program or attended an unaccredited high school. You attended a high school or college outside of the United States and are unable to have those grades converted to a 4.00 scale or your school did not grade in a manner that can be readily converted to a 4.00 scale. Students who have been out of school for five years can choose to submit either test scores or their GPA. – Scores from the California High School Proficiency Examination (CHSPE) cannot be accepted in lieu of a high school GPA, but passing the CHSPE does meet the high school graduation requirement of the Entitlement Cal Grant program. Also, grade reports, transcripts, and other proficiency certificates WILL NOT BE ACCEPTED. – Only scores from the SAT reasoning test WILL BE ACCEPTED. Subject test scores will NOT BE PROCESSED. 10. Student signature: By signing this form, you certify that you have read these instructions and that the information you provided is correct. It is illegal to report false or misleading information on this form and doing so may result in any Cal Grant award being revoked. Once you have filled out the student information, take the form to your school and request that they verify your GPA. Be aware that if your school will be electronically submitting your GPA to the California Student Aid Commission, you do not need to submit this form. It is your responsibility to verify that the school will be submitting your GPA for you. FOR SCHOOL USE ONLY SECTION GPA IS BASED ON HIGH SCHOOL COURSEWORK: Fill in this bubble ONLY if the GPA is based on high school coursework. REGIONAL ACCREDITATION AGENCY (High schools only) Please enter the Regional accreditation agency by which your High school is accredited. CALIFORNIA COMMUNITY COLLEGE RE-ESTABLISHED GPA: Fill in this bubble ONLY if the GPA being certified is based on at least 16 but less than 24 units completed at a California Community College. If the GPA is based on college units, and is not a reestablished GPA as described above, do not fill in any bubble. GPA VERIFIER’S SCHOOL CODE: High schools use their College Board school code; colleges use their USED OPE ID code. VERIFIED STUDENT GPA: Fill in ALL three GPA spaces. Cal Grant GPAs are calculated on a 4.00 scale. High Schools certifying GPAs MUST be accredited or have a UC approved course list in order to verify GPAs. Students not attending accredited high schools should provide either a GED, SAT or ACT score. After the school completes the GPA information, fold form into thirds, insert into a #10 standard business envelope, apply the appropriate postage, obtain a certificate of mailing from post office (optional) and mail to: California Student Aid Commission Cal Grant Operations P.O. Box 419077 Rancho Cordova, CA 95741-9077 G-4 (09/2010) Cal Grant GPA Calculation Instructions There are four categories of GPAs used for Cal Grant award selection - High School, College, Regular Community College and Reestablished Community College. High School GPA College GPA A high school GPA is calculated on a 4.00 scale to two decimal places (between 0.00 and 4.00). Do not use a weighted scale. Convert any grades with extra weighting for honors and advanced placement classes to a 4.00 scale before calculating the GPA. GPAs calculated beyond a 4.00 scale will not be accepted. A college GPA is calculated on all college work completed, except for nontransferable units and courses not counted in the computation for admission to a California public institution of higher education that grants a baccalaureate degree. The definition of the phrases “all college work completed” and “nontransferable units” and “courses not counted in the computation for admission to a California public institution of higher education that grants a baccalaureate degree” are described below. A college GPA or a community college GPA must be computed for a minimum of 24 semester units or its equivalent regardless of the grades received. The phrase “all college work completed” includes all coursework for which grades are known to the official reporting the GPA and that are accepted for credit at the school reporting the GPA. Failing grades must be included. For students who have not yet graduated high school, calculate the GPA using all academic course work for the sophomore year, the summer following the sophomore year, the junior year, and the summer following the junior year. The high school GPA excludes physical education (PE), Reserve Officer Training Corps (ROTC), and remedial courses. Remedial work is defined as any course that is not counted toward high school graduation. Failing grades must be included in the GPA calculation unless the course has been retaken. GPAs for “accelerated” high school juniors graduating in spring 2010 should be calculated using academic course work earned during the student’s sophomore year and the summer following the sophomore year, as well as all course work completed in the junior year by the time of certification. For students who are out of high school but have not earned sufficient college level units to allow calculation of either a college GPA or reestablished GPA or as explained below, the GPA must be calculated from high school course work earned from the student’s sophomore year onward, regardless of whether the student graduated. Competitive Cal Grant awards can be made to students who have not graduated high school. Regular California Community College GPA For purposes of computing a community college GPA for a Cal Grant award, “nontransferable units” and “courses not counted in the computation for admission to a California public institution of higher education that grants a baccalaureate degree” mean all courses except “Associate Degree Credit Courses” as defined by Title 5, Chapter 6, Article 1, Section 55002(a) of the California Code of Regulations. Reestablished Community College GPA A reestablished community college GPA is calculated on at least 16 but less than 24 semester units or the equivalent. For any Cal Grant deadline, a school may submit either a reestablished GPA or a “regular” community college GPA calculated on at least 24 semester units, or the equivalent. A reestablished GPA is good only for Competitive Cal Grant B consideration. Only a California Community College may submit a reestablished GPA. College GPA - Baccalaureate Degree Granting Institution For purposes of computing a college GPA by an institution that grants a baccalaureate degree, “nontransferable units” and “courses not counted in the computation for admission to a California public institution of higher education that grants a baccalaureate degree” are those courses which do not earn credit for a baccalaureate degree from the reporting institution. College GPA - Associate Degree Granting Institution For purposes of computing a college grade point average by a postsecondary institution that grants an associate degree, “nontransferable units” and “courses not counted in the computation for admission to a California public institution of higher education that grants a “baccalaureate degree” are those courses which do not earn credit for an associate degree at the reporting institution. College GPA - Non-degree Granting Institution For purposes of computing a college GPA by a postsecondary institution that does not grant a baccalaureate or an associate degree: (A) “nontransferable units” are those units which are not used in satisfying requirements for earning a baccalaureate degree from a California public institution of higher education that grants such a degree; (B) “courses not counted in the computation for admission to a California public institution of higher education that grants a baccalaureate degree” are any courses for which the earned grade is not used in the computation of a GPA in determining admission eligibility, whether or not units earned for the course are transferable to such an institution. If the GPA is based on college units, and is not a reestablished GPA as described above, do not fill in any bubble.