KEAS Program Application Fall 2019
The KEAS Program is now accepting applications for students interested in being part of our program in Fall of 2019.
In completing this form, you will be asked to RSVP to one of the KEAS Info Sessions.

***If you are a new student or you did not attend ECC in the Spring 2019, you must register for El Camino College prior to applying to the KEAS Program.

Questions? Call 310-660-3593 x7716

Email address *
ECC Email Address *
Your answer
First Name *
Your answer
Last Name *
Your answer
ECC Student ID Number *
Your answer
Date of Birth *
(MM/DD/YYYY)
Your answer
Gender *
Main Contact Phone Number *
Your answer
Alternate/ Home Phone Number
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
How do you identify? (Check all that apply) *
Required
Are you a member or a participant in any of the following programs? *
Required
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