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 San Diego College of Continuing Education (SDCCE) CalWORKs Application (during COVID-19 remote services)
Welcome to SDCCE CalWORKs!  

To make thinks a little easier during our global crisis, we are temporarily collecting your application for the SDCCE CalWORKs program using Google Forms.  Having the information requested below will help us serve you better. After you complete this Google Form then we can schedule an orientation for you to receive services from our program.  

Please note that due to the Family Educational Rights and Privacy Act (FERPA), we may only communicate directly with the student (and not the spouse or other family members of the student).  If language assistance is needed, we can arrange for language support.
Last Name *
First Name *
Gender *
Your County Case Number *
Your Student ID Number *
Mailing Address & Zip Code *
Your Phone Number *
Do we have permission to leave you a detailed message at this phone number (Voice and Text)? *
Do you currently receive Cash Aid for yourself and your children? *
Please help us understand your Ethnicity or National Origin.   (This information helps us understand and advocate for the diversity needs of the students in our program.) *
Required
What is your native language? *
What other languages do you speak?
Please help us understand your family composition. *
Please help us understand a little more about your situation. *
How many children do you have? Please list their gender and age *
Do YOU have any special needs or disabilities? *
Do you have a computer (laptop) and internet access?  Please check one that applies: *
Where do you receive your Welfare to Work Employment Case Management services? *
Please enter the full name of your Employment Case Manager (ECM) or Employment Training Advisor (ETA)
Please enter your Employment Case Manager's (ECM) or Employment Training Advisor's (ETA) email address.
Please enter your Employment Case Manager's (ECM) or Employment Training Advisor's (ETA) phone number.
What is your Career Goal? *
What is your educational goal for attending San Diego College of Continuing Education?  (please check all that apply to you) *
Required
Are you currently employed? *
Please tell about the kind of work do you do.
STUDENT AGREEMENT: I understand and agree to the following guidelines and requirements to remain eligible for CalWORKs Program services at San Diego Continuing Education.

Complete a CalWORKs Program Orientation.

Turn in a copy of my Welfare-to-Work (WTW) Plan each semester.

Meet with a CalWORKs Counselor each semester to create an Individual Training Plan (ITP) or update my Educational Plan.  

Make an appointment to update my ITP when I add or drop classes.

I will notify a CalWORKs Counselor immediately if I experience any difficulties (transportation, childcare, course work, etc.) that interferes my school.

Notify the CalWORKs office if any changes with my case worker at PCG/EQUUS or if I am sanctioned by the county.

Notify if any changes to personal information (phone number, address, or email).

I will submit the NOA 116 (Monthly Attendance Verification form) before the 5th of the month to my county case worker.
AUTHORIZATION TO RELEASE INFORMATION:  By checking the box below, I give my permission for any San Diego College of Continuing Education  CalWORKs  Program Staff  to communicate with:  (1) the County of San Diego Health and Human Services Agency (and their representatives); AND (2) my assigned Welfare to Work Employment Case Management Agency (Public Consulting Group or ResCare) and their staff.  I understand that the purpose of this communication is to provide information relevant to my Welfare to Work Plan, to access necessary Supportive Services, and to aid resolution to challenges I may experience while receiving benefits in the County CalWORKs system. *
Required
ATTENTION:  I understand that the information I provided on this application will be used to determine my eligibility for the San Diego College of Continuing Education  CalWORKs  Program.  By entering my full name below, I also certify that this information is true and accurate to the best of my knowledge. *
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