EAOP/DCAC Pre-Intake Form
Are you interested in meeting with your EAOP/DCAC College Adviser, Ms. Jessica? Please fill out this Pre-Intake Form so Ms. Jessica has a better idea of what colleges and majors you're interested in to better serve you!

Please expect an e-mail regarding your appointment from Ms. Jessica no later than a week of when you filled this form.

Looking forward to our future meetings!

Have any questions? Please e-mail Jessica at jessicathach@berkeley.edu

First Name *
Your answer
Last Name *
Your answer
Student ID# *
Your answer
Grade *
Your answer
Are you a part of any of the programs listed? *
Required
Gender *
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Date of Birth *
MM
/
DD
/
YYYY
Ethnicity *
Your answer
E-mail *
Your answer
Home Phone # *
Put "N/A" if you do not have one.
Your answer
Cell Phone # *
Put "N/A" if you do not have one.
Your answer
Mailing Address *
Your answer
City *
Your answer
Zip Code *
Your answer
List the best period(s) for you to be pulled out. *
Your answer
Which Academy are you in? *
Required
My immediate post graduation plans include (Check all that apply) *
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I will apply to the following University of California Campus(es). Check all that apply.
I will apply to the following California State University Campus(es). Check all that apply.
I will apply to the following California Community College Campus(es). Check all that apply.
What other Privates Colleges or Tech Schools will you be applying for?
Your answer
What major or program are you interested in?
Your answer
Please indicate which entrance exams you have already taken
List score if available. If you are registered to take an upcoming exam, please provide test date. *
Example: SAT Reasoning: (Score - Date)
Your answer
Which Financial Aid Application will you fill out?
List all the scholarships you will be applying to:
Your answer
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