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Special Programs & Services Application

Personal Information

Name
Address
*All correspondence through Special Programs & Services will only be sent through your student e-mail (my.barstow.edu)*
Ethnic Background

Educational Background

Family Information

Military Affiliation

Disability Services

Emergency Contact

Signature & Release

Photo Release

Occasionally the Special Programs and Services department may obtain photos of students. If you elect to release your photo you will grant permission to Barstow Community College District to use your photo for promotional use including but not limited to fliers, newsletters and brochures which may be published on physical documents or virtual/electronic content. If you do agree you waive any rights to inspect, edit or approve the final publication with your photograph. Please see staff for any questions regarding the photo release.

All applicants must read this statement and sign below:

I hereby affirm, under penalty of perjury, that all of the information provided on this form is true and complete to the best of my knowledge. I agree to provide proof/documentation of these statements if requested by a college official. I realize that any false statement or failure to provide follow up information may be cause for the denial or termination of Special Programs services. I understand that it may take up to 7 business days for my application to be processed. I authorize the sharing of information regarding this application between Barstow Community College, the college district, and the Chancellor’s Office of the California Community Colleges.

By checking this box I understand that typing my name will be considered my official electronic signature

Mutual Responsibility Contract

Select the program(s) you participate in
SPS PROGRAM RESPONSIBILITIES

As a Special Programs and Services participant, you may be eligible for the following services based on program and funding availability ** Will vary by program and may not be duplicated
  • Support Services Assessment
  • Priority Enrollment and Registration Assistance
  • Academic/Personal Advising and Counseling
  • Textbook Assistance
  • Transportation Assistance
  • School Supplies                
  • Tutorial Services Assistance
  • Financial Aid Application Assistance
  • Cultural/Education Enrichment Activities
  • Transitional Support Services
  • Campus and Community Referrals
  • Childcare Stipends (EOPS/CARE Only)
SPS STUDENT RESPONSIBILITIES
ADDITIONAL REQUIREMENTS FOR CALWORKS STUDENTS:
ADDITIONAL REQUIREMENTS FOR VETS/YESS STUDENTS:
By signing below, I verify that I understand and agree to fulfill all SPS Program Requirements listed above. I understand that failure to do so may result in program dismissal or a hold being placed on my account.