SAN BERNARDINO VALLEY COLLEGE CALWORKS & WORKFORCE DEVELOPMENT INTAKE PACKET

  • INTAKE INFORMATION FORM

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Personal Information

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  • Household

Program Eligibility

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  • Are you a participant in any in the following programs?
  • Are you a current SBVC student?
  • Are you currently receiving CalWorks Cash Aid?
  • Have you signed a Welfare-to-Work plan?
  • Are you currently Exempt?
  • Have you attended other colleges?

Employment History

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  • Are you currently employed?
  • Are you interested in the Work-Study or Job Placement?

Support of Services

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  • Have you applied for Financial Aid?
  • Please select program(s) you receive supportive services from:
  • Please select the organization you receive child care services from:

RELEASE OF INFORMATION

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  • I give permission to San Bernardino Valley College and the Transitional Assistance Department, Workforce Development Department and the Employment Development Department personnel to share information relevant to my vocational and employment activities. The purpose of this release is to help me meet reporting requirements. I understand that I have a right to refuse to sign, which may limit the scope of this Release of Information, and this release is subject to cancellation by me at any time.

  • Date will be captured on form submission

  • Contract & Orientation Agreement


    To participate in the CalWORKs Workforce Development Program an agreement will be made with the student and the CalWORKs Workforce Development Department. Please read and initial each of the following program requirements that have been set forth.

    PROGRAM COUNSELOR:

    I am required to meet with the Program Counselor to develop an Educational Goal Plan.
    I am required to meet with the Program Counselor a minimum of two times each semester.

    1.First Contact - Initial Contact
    2.Second Contact - After Progress Report.

    You may revise your Educational Goal Plan at any time, but approval must be acquired first from the WTW Worker or Sponsorship Case Manger prior to changes. Then Schedule an appointment with the Program counselor for official revisions.
  • By initialing I understand and agree to the Program Requirements:
  • PROGRAM DOCUMENTATION:

    I am required to submit a Registration Statement each semester as part of the program eligibility. If any changes have been made during the semester you are required to submit an updated registration statement.

    I am required to submit a monthly Attendance Form on the 5th of each month for each course I am enrolled in for that semester.

    I am required to submit a Progress Report once a semester. Due dates TBD. A notification will be sent out each semester.

    I am required to submit a proof of Cash Aid, WtW contract or Exemption Letter each semester I request services. These documents can be obtained from your County Worker. If any changes occur during the semester you are required to submit all updates to the SBVC CalWORKs office. (CalWORKs students only)
  • By initialing I understand and agree to the Program Requirement:
  • SERVICES:
    Program services (books, transportation, childcare etc.) will be rendered once all required documentation and/or program requirements have been met.
    ADDITIONAL INFORMATION:
    If at any time you are placed on academic progress probation or become subject to dismissal, contact the office to schedule an appointment with the program counselor immediately. The program counselor will work with you to develop an intervention plan.
    I have read the Programs Contract and agree to abide by the CalWORKs Workforce Development guidelines and regulations. Failure to abide by the guidelines and regulations may limit or cancel my program services.
  • Date will be captured on form submission