Summer 2013 Schedule of classes - Hartnell College

CTEA/VTEA Survey
STEP 1A
Funding Occupational Education at Hartnell College
Hartnell College is required to report the number of students enrolled in occupational classes. The college receives money based on the
number of students enrolled in these classes. Your participation in this brief survey is critical to the continuation and improvement of
occupational programs at Hartnell. All information you provide is strictly confidential. This survey should only take a couple of minutes
to complete.
1. Student Name: Enter the first initial of your first name and the first four letters of your last name.
(Example Jone Smith = JSMIT)
2. Hartnell Student ID No. or SSN
3. Are you receiving aid from any of the following?
a. Cal Works, TANF (formerly AFDC) Yes No
b. SSI (Supplemental Security Income) Yes No
c. GA (General Assistance program) Yes No
d. Section 8 Housing Assistance (HUD) Yes No
4. Does your income qualify you for a Board of Governors (BOGW) Fee Waiver? Yes No
Please use the table below to determine if you qualify for a Board of Governors (BOGW) Fee Waiver.
(If you are considered a dependent student, use parent(s) income for determination.)
Family Size
2011 Income
1
$16,335
2
$22,065
3
$27,795
4
$33,525
5
$39,255
6
$44,985
7
$50,715
8
$56,445
Each Additional Family Member $5,730
5. Are you a single parent? Yes No
(You are a single parent if you are not married or are legally separated, AND have full or joint custody of a child
or are pregnant.)
6. Are you a displaced homemaker? Yes No
(You are a displaced homemaker if you cared for your family without pay, AND are unemployed or are now
experiencing difficulty finding employment.)
7. Are you a migrant worker? Yes No
(You are a migrant worker if you work in agriculture, dairy, or fishing, AND you had to move (within the past 3 years)
to obtain temporary or seasonal employment in agriculture, dairy, or fishing.)
8. Is English the primary language you speak at home? Yes No
9. If you answered "No" to question 8, what is the primary language you speak at home?
Thank you for your assistance in supporting Hartnell College.
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