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EASTERN WASHINGTON UNIVERSITY – COLLEGE ASSISTANCE MIGRANT PROGRAM APPLICATION 2021-2022Full Name:DOB:CAMP STUDENT APPLICATION2021-2022 Academic YearDeadline September 1, 2021Return Application:Email: camp@ewu.eduBEFORE YOU APPLY MAKE SURE THE FOLLOWING IS TRUE:1. You are applying as a first-time freshman for Fall Quarter 20212. Due to federal funding, you are a U.S. Citizen or Legal Permanent Resident3. You are an eligible migrant student. This means you can provide proof of your OR your immediate familymember’s history of agricultural farm work (ex. Picking apples).4. You have submitted or plan to submit your FAFSA for the 2021-2022 Academic YearThe College Assistance Migrant Program is a federally funded program designed to support students from migrantand seasonal farm worker backgrounds during their first year of college (Fall 2021-Spring 2022). The programprovides students with financial assistance and support services with the goal of preparing them to continue theireducation and becoming college graduates.Services Include: Financial Aid AdvisingQuarterly Stipend (Fall, Winter & Spring)Academic AdvisingTutoringEWU - C.A.M.P.Monroe HallCheney, WA 99004 Cultural and Educational EventsPeer MentorshipLeadership OpportunitiesCareer CounselingPh: (509) 359-2230Email: camp@ewu.eduinside.ewu.edu/camp
EASTERN WASHINGTON UNIVERSITY – COLLEGE ASSISTANCE MIGRANT PROGRAM APPLICATION 2021-2022Full Name:DOB:In order for our staff to use the most respectful language when addressing you, understanding you better andfulfilling grant requirements, we require the following information. Please help us serve you better by selecting thebest answers to these questions. Thank you.PERSONAL/DEMOGRAPHIC INFORMATIONFirst Name: Middle Initial: Last Name:Street Address:City: State:Zip:Mailing Address (if different from Mailing Address):City: State:Zip: Date of Birth: / /Primary Phone: ( )Secondary Phone: ( )MMSex:FemaleMaleDecline to AnswerDDYYYYPreferred Pronouns:U.S. Residency:HeU.S. CitizenSheSSN#: - -TheyLegal Permanent Resident(Please attach a copy of your permanent resident card)Pronoun Not ListedPlease Specify:No Pronoun PreferenceRace: *Select All That Apply*American Indian/Alaska Native:Black and/or African AmericanWhite/CaucasianAsian:Native Hawaiian/Pacific Islander:Decline to exicanChicanxPuerto RicanOther Hispanic/LatinxDecline to AnswerPreferred Email: Intended Major:EDUCATION(*Answer All That Apply*)High School Name:HS Graduation Date: / /MMDid you earn a GED?DDYESHS GPA (4.0 Scale):YYYYNODate Completed: /MMYYYYIf you earned a GED, where?1 P a g e
EASTERN WASHINGTON UNIVERSITY – COLLEGE ASSISTANCE MIGRANT PROGRAM APPLICATION 2021-2022Full Name:DOB:EDUCATION - CONTINUEDColleges Attended (if any):1.)2.)Total college credits earned?FAMILY INFORMATIONParent/Guardian 1 Information:Name:FirstMiddleLastStreet Address:City: State:Zip:Phone: ( ) -Mailing Address (if different from Mailing Address):City: State:Zip:Place of Employment: Position:Company Name (if parent is unemployed, write “unemployed”)Highest Grade Level Completed:Highest Degree Earned:Parent/Guardian 2 Information:Name:FirstMiddleLastStreet Address:City: State:Zip:Phone: ( ) -Mailing Address (if different from Mailing Address):City: State:Zip:Place of Employment: Position:Company Name (if parent is unemployed, write “unemployed”)Highest Grade Level Completed:Highest Degree Earned:FAMILY INCOMEHousehold Size:# of Family Members in College:(Including yourself, # of people in your home)(include yourself in this count)Approx. Yearly Family Income: Did you submit the 2021-2022 FAFSA?YESNO2 P a g e
EASTERN WASHINGTON UNIVERSITY – COLLEGE ASSISTANCE MIGRANT PROGRAM APPLICATION 2021-2022Full Name:DOB:SHORT ANSWER QUESTIONSIn 3-4 complete sentences answer the following questions. Remember to include detail. This is your opportunity to givethe reader of your application a sense of who you are as a person and as a future leader at Eastern WashingtonUniversity.Describe yourself. What is something important CAMP should know about you?Why is pursuing a higher education important to you?What motivates you to succeed academically?Why are you interested in attending EWU through CAMP?3 P a g e
EASTERN WASHINGTON UNIVERSITY – COLLEGE ASSISTANCE MIGRANT PROGRAM APPLICATION 2021-2022Full Name:DOB:VERIFICATION OF MIGRANT OR SEASONAL FARMWORKER STATUSTo be eligible for services provided by the College Assistance Migrant Program (CAMP) under the guidelines establishedby the U.S. Department of Education, the applicant or the applicant’s immediate family or guardian must have worked atleast 75 days within the last two years in agriculture as a migrant or seasonal farmworker. This includes any activitydirectly related to the production of crops, dairy products, poultry, or livestock, the cultivation or harvesting or trees, orfish farms OR be eligible to participate or have participated in programs under Subpart 1 of Chapter 1 of Title 1 of theElementary and Secondary Education Act of 1965, or WIA of 1998 program.Please check and provide ONE of the following forms of verification:Migrant Education ProgramPlease provide your identification # (COE):Employer verification for at least 75 days of employment within the last 2 yearsPlease fill out this additional information:Name of Employer: Location of Employment:Start Date of Employment: End Date of Employment: # of Days Worked in the Past 2 Yrs:Name of Supervisor: Phone Number to Contact Employer:Type of Work Performed:(You will also need to go to our website and download the CAMP Employment Verification form)Letter verifying participation in the Washington Farmworker Investment 167 Program(Please attach copy of letter)AUTHORIZED STUDENT SIGNATUREI understand that to be accepted and receive services from the College Assistance Migrant Program (CAMP) the programmust access my student records. I therefore authorize CAMP to have access to my records at Eastern WashingtonUniversity. Records include grades, transcripts and enrollment documents, financial aid information, government andstate documents and test scores.I certify to the best of my knowledge that the information I have provided on this application is complete and true.Failure to disclose and submit complete and accurate information may result in the denial of acceptance to the EasternWashington University CAMP Program.Signature:Date:*** Electronic Signature: By typing my full name into this form I am signing this application electronically. I agreethat my electronic signature is the legal equivalent of my manual signature on this application. ***Return Application:Email: camp@ewu.edu4 P a g e
EASTERN WASHINGTON UNIVERSITY – COLLEGE ASSISTANCE MIGRANT PROGRAM APPLICATION 2021-2022 Full Name: DOB: EWU - C.A.M.P. Monroe Hall Cheney, WA 99004 Ph: (509) 359-2230 Email: camp@ewu.edu inside.ewu.edu/camp CAMP STUDENT APPLICATION 2021-2022 Academic Year Deadline September 1, 2021 Return Applicatio
