CARE Certification Form 2021-2022

CARE regulations require coordination of applicable educational support services and welfare-to-work activities and verification of financial resources. The information provided will be used only to determine CARE program eligibility and will be kept confidential pursuant to Sections 76200-76246 of the California Education Code and the 1974 Family Educational Rights and Privacy Act.

To apply for the CARE program, county documentation (ie Verification of Benefits, Notice of Action) IS REQUIRED. Documents can be downloaded under My Benefits at https://yourbenefits.laclrs.org/ybn/Index.html

If you need assistance, email careinfo@elcamino.edu. CARE Staff will contact you within 2 to 3 business days.  

Program Overview: The Cooperative Agencies Resources for Education (CARE) program was established in 1982 by the State of California as a supplemental component of EOPS to provide educational support services and activities for the academically underprepared, welfare-dependent, single head of household student population. CARE specifically serves EOPS students who, at the time of acceptance into the program, are 18 years old and single heads of household, current recipients of assistance from CalWORKs/TANF/Tribal TANF (California Work Opportunity and Responsibility to Kids/Temporary Assistance for Needy Families) for themselves or their dependents and are enrolled as full-time community college students (some exceptions to full-time enrollment exist).


Name*
Are you, or your dependents, currently receiving TANF or CalWORKs (eligibility requirement)?*
Are you considered Single Head of Household?*
Current Marital Status *
Date TANF/CalWORKs benefit began*
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Child 1

Please select your child's gender.
Do you need to add information for another child?

Child 2

Please select your child's gender.*
Do you need to add information for another child?*

Child 3

Please select your child's gender.*
Do you need to add information for another child?*

Child 4

Please select your child's gender.*
Do you need to add information for another child?*

Child 5

Please select your child's gender.*
Do you need to add information for another child?*

Child 6

Please select your child's gender.*
Do you need to add information for another child?*

Child 7

Please select your child's gender.*
Do you need to add information for another child?*
I certify that I have met all of the CARE eligibility requirement listed above. I declare under penalty of perjury that all information on this form is correct. I understand that falsifying or withholding information required on this form is grounds for program disqualification and/or dismissal.*
Use your mouse or finger to draw your signature above

CARE Staff Verification

Student Status
Applicant is CARE Eligible
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CARE File Complete