Student-Application

Birth Date

Month

Day

Year

Gender

Race/Ethnicity

Street Address

Street Address Line 2

Street Address Line 3

Are you a first generation college student (neither parent is a college graduate)?

Yes

No

Student Status

What is your greatest concern about attending college?

How did you hear about the Umoja Learning Community?

If counselor referral, please provide name of the counselor

Do you have any skills, interest or talents you might consider sharing with other students in the community? If so, what are they?

If mentoring is available, please indicate preference

Male

Female

Educational Goal

What types of schools are you interested in transferring to ?

University of California System Institutions

California State University System Institutions

Historically Black Colleges and Universities (HBCU)

Private Institution

Enrollment Status

New to college

Continuing student

Transfer (from another college)

Full time (12 units or more)

Part-time (less than 12 units)

Citizenship Status

U. S. Citizen

Permanent Resident

Other

Financial Aid status

Awarded

Not Awarded

Major and/or career interests?

Are you interested in working in the healthcare profession?

Yes

No

Healthcare encompasses a broad group of health professionals who use scientific principles and evidence-based practice for the diagnosis, evaluation and treatment of acute and chronic diseases; promote disease prevention and wellness for optimum health, and apply administration and management skills to support health care systems in a variety of settings. Allied health care professionals work in health care teams to make the health care system function by providing a range of diagnostic, technical, therapeutic and direct patient care and support services that are critical to the other health professionals they work with and the patients they serve.

Coastline Student Application