LA College Promise Application Late Start Spring 2022

Request edit access

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Thank you for your interest in Los Angeles College Promise at Los Angeles Harbor College. Our college is committed to your success and would love to get to know more about you! If you would like to be considered for participation in a comprehensive student success program, Harbor Advantage, which oversees LA College Promise and provides you with many resources then please fill out the form below.

𝐏𝐋𝐄𝐀𝐒𝐄 𝐍𝐎𝐓𝐄: Spring 2022 𝐈𝐧𝐜𝐨𝐦𝐢𝐧𝐠 𝐬𝐭𝐮𝐝𝐞𝐧𝐭𝐬 𝐰𝐢𝐥𝐥 𝐛𝐞 𝐞𝐥𝐢𝐠𝐢𝐛𝐥𝐞 𝐟𝐨𝐫 𝐭𝐡𝐞 𝐟𝐮𝐥𝐥 𝐟𝐫𝐞𝐞 𝐲𝐞𝐚𝐫 & 1/2 𝐭𝐮𝐢𝐭𝐢𝐨𝐧 𝐜𝐨𝐯𝐞𝐫𝐚𝐠𝐞.

**Winter and Summer terms will not be covered by LA College Promise until further consideration.

We are looking forward to working with you!

Confidentiality

The information provided on this intake form will not be shared with the public. It will remain confidential and will be utilized to see how to best provide resources to students at Los Angeles Harbor College.

First name *

Middle Name or Initial

Last Name *

Date of Birth *

YYYY

Harbor Student Identification Number (90x-xxx-xxx) *

If you do not have a LACCD Student ID Number, please put "N/A" below! Once you have completed the LA College Promise Application 2022-2023, apply to LAHC to become a student by visiting lahc.edu or call our Outreach office at (310) 233-4330 for support.

Best Phone Number to reach you (000-000-0000) *

If you do not have a phone number, please insert "N/A" below.

Alternative Phone Number

Primary Email Address *

This email will be used to contact you. Make sure you check your email on a DAILY BASIS, to ensure you receive important emails and are up to date with requirements and upcoming events. CREATE PROFESSIONAL EMAIL IF YOU DO NOT HAVE ONE ALREADY & INSERT BELOW. Do not use a high school email.

Home Address (Street, City, Zip Code) *

What is your current gender identity? *

If you identify with any other gender identity, please write your preference in the "OTHER" section provided.

Male

Female

Decline to answer

Other:

How did you hear about Los Angeles Harbor College? (Check all that apply) *

Outreach and Recruitment

Harbor Advantage program

High School counselor

It's in my local community

Mail

Other:

Required

Did you graduate from high school? *

Yes

Obtained GED/HiSET

In Progress

Other:

Which high school/ adult school/ other institution are you attending or attended? *

In which city/state was your high school/ adult school/ other institution located? *

Graduation date *

YYYY

Do you plan on working while attending college? *

Yes, part-time

Yes, full-time

Do you have a specific MAJOR/CAREER you would like to pursue? If so, please state below. *

What is your educational goal? (Check all that apply) *

Certificate

Associate Degree

Transfer to a 4 year institution

Unsure

Other:

Required

Los Angeles Harbor College’s Career Technical Education (CTE) programs provide educational, vocational, and technical training that will lead to employment, career advancement, or transfer to a university.

CTE Programs include : Accounting, Administration of Justice, Architecture & Design, Business Administration, Nursing, Child Development, Networking, ITTP Certification, Commercial Music, Computer Applications, Computer Information System, Culinary Arts, Drafting, Real Estate

Are you interested in a CTE program? *

Yes

Maybe

Other:

Have you completed a current Free Application for Federal Student Aid (FAFSA) or CA Dream Act? *

A financial aid application is needed on file in order to be eligible for the College Promise scholarship.

Yes

Not sure

Are you interested in learning more about STEM (Science Technology Engineering Math)? *

Yes

Maybe

Are you a veteran or the immediate relative of a veteran? *

Yes

Some individuals might find the next few questions to be sensitive topics. Just a reminder, that the information provided on this intake form will not be shared with the public.

Are you a current or former foster youth? *

Yes

Decline to answer

Have you had an Individualized Educational Plan (IEP) or 504 Plan? *

Yes

Unsure

Decline to answer

Are you experiencing any of these hardships or insecurities below? *

As defined by LACCD: "Homeless" means lacking fixed, regular and adequate housing, which includes living in shelters, motels or cars, or temporarily living with other people because you had nowhere else to go.

Trouble with housing

Lack of food

Financial

Getting books or school supplies

Does not apply

Other:

Required

Clear form

Never submit passwords through Google Forms.

This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Forms