EOPS & CalWORKs Remote Counseling Appointment Request
In order to schedule a remote counseling appointment, I agree to the following:

1. I must show my SDCCD photo ID or a government issued ID to the counselor at the beginning of the counseling session. If I do not have a photo ID (which is preferred), then a two question authentication process will be required prior to releasing any academic information in the remote counseling environment.

2. I hereby grant permission for San Diego Miramar College EOPS & CalWORKs Counselors to share academic information about myself during a live remote counseling appointment via Zoom. When requesting a remote appointment and while communicating with the counselor, I must authentically represent myself in all aspects. I further understand it is my responsibility to be in a confidential setting during the appointment.

3. I understand that due to confidentiality purposes, Counseling Sessions should not be recorded. Recording counseling sessions is in violation of District Policies.
Email address *
Click to acknowledge you have read and agree to the above statements. *
What is your current Miramar EOPS or CalWORKs status? *
First Name *
Last Name *
Student ID# *
Phone Number *
***NOTICE***
*Please note that you must be active EOPS student to have your appointment scheduled. If you had not met with our counselors this previous semester for any of the 3 required appointments you will have to reapply as a New EOPS Student for the Fall 2020 semester. You can find our application on our website here https://www.sdmiramar.edu/campus/eops *
Please select or describe reason for appointment: *
Required
Miramar EOPS/CalWORKs remote hours of operation are Monday-Thursday 8am-6pm, Fridays 8am-3pm: When are you available to meet for a Zoom appointment? Please select all options that apply. Note that all appointments may be scheduled for 1 hour or longer depending on appointment reason. *
Required
Which days are you available? Please select all options that apply. *
Required
Do you have a Counselor preference or preferences? Please note, that depending upon availability, we may not be able to schedule you an appointment with your preferred counselor right away. *
Required
If your preferred counselor(s) chosen above is not available, do you prefer to wait until you can meet with them or can we schedule you with another counselor? *
Would you prefer a phone or zoom online first appointment ? * In both cases, you will be receiving an email with instructions on how to join the appointment as soon as we schedule it. * *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy