Las Vias Intake Form
CCC Student ID
Your answer
First Name *
Primer Nombre
Your answer
Last Name *
Your answer
Cell Phone # or best number to reach you *
# de Telefono
Your answer
CCC Student Email *
Email address issued by Cumberland: (USERNAME)
Your answer
Birth Date *
Fecha de Nacimiento
High School attended/graduated:
High School secundaria atendido/graduado
Are you a first year student? (Never attended college) *
Eres estudiante universitario de primer año?
What was/will be your first semester at CCC? *
¿Cuál fue/será tu primer semestre en CCC?
I plan to attend CCC as a...
Yo sere estudiante...
Tell us when you prefer to meet with your advisor: *
Cuando prefieres reunirse con su consejero/a?
What are your educational goals at CCC?
¿Cuales son tus metas educacionales en CCC?
What is your major? (program you declared on your CCC application)
¿Cuál es el programa de estudio declarado en tu solicitud de CCC?
Do your parents have a 4 year degree?
¿Sus padres tienen una licenciatura ?
Are you currently employed?
¿Estas trabajando?
If yes, how many hours per week?
Si trabajas, cuantas horas a la semana?
Your answer
Are you eligible to apply for Financial Aid?
¿Eres elegible para solicitar ayuda financiera para los estudios?
Regarding Financial Aid:
En cuanto a la ayuda financiera:
Will you be eligible for the following scholarships?
¿Eres elegible?
Do you have reliable transportation to and from the college?
¿Tienes transportación segura para llegar al colegio?
Have you ever been classified with a learning disability?
¿Has tenido algun dificultad escolar o disibilidad de aprender?
Are you currently part of the Educational Opportunity Fund (EOF) or Student Support Services (SSS) program?
How did you hear about the Las Vias Program? (Describe below)
¿Cómo se enteró sobre el programa Las Vias? (Describir abajo)
Your answer
Students starting in Fall 2019 may be interested in participating in the Las Vias Take-the-Lead Summer Program. Please check your email for more information.
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