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<div id="printwrap">
<div id="nav-left">
<div id="headertop">
<h1 id="website-title" class="primary">MigrantStudents.org</h1>
<h2 id="website-slogan" class="secondary">Powered by the CAMP Alumni Association - "Cultivating Leadership!"</h2>
</div>
<div id="inner">
<div style="height: 1640px;" id="navcontainer" class="tertiary">
<div id="nav-wrapper" class="tertiary">
<div><a id="sublink2" href="http://www.migrantstudents.org/home.html" class="tertiary" target="_self"><h3>Home</h3></a></div>
<div><a id="sublink3" href="http://www.migrantstudents.org/whoweare.html" class="tertiary" target="_self"><h3>Who We Are</h3></a></div>
<div><a id="sublink4" href="http://www.migrantstudents.org/highschoolstudents.html" class="tertiary" target="_self"><h3>High School Students</h3></a></div>
<div><a id="sublink5" href="http://www.migrantstudents.org/hepstudents.html" class="tertiary" target="_self"><h3>HEP Students</h3></a></div>
<div><a id="sublink6" href="http://www.migrantstudents.org/campstudents.html" class="tertiary" target="_self"><h3>CAMP Students</h3></a></div>
<div><a id="sublink7" href="http://www.migrantstudents.org/campalumni.html" class="tertiary" target="_self"><h3>CAMP Alumni</h3></a></div>
<div><a id="sublink8" href="http://www.migrantstudents.org/campaamembership.html" class="tertiary" target="_self"><h3>CAMPAA Membership</h3></a></div>
<div><a id="sublink9" href="http://www.migrantstudents.org/campaachapterlocations.html" class="tertiary" target="_self"><h3>CAMPAA Chapter Locations</h3></a></div>
<div><a id="sublink10" href="http://www.migrantstudents.org/scholarshipsources.html" class="tertiary" target="_self"><h3>Scholarship Sources</h3></a></div>
<div><a id="sublink11" href="http://www.migrantstudents.org/internshipopportunities.html" class="tertiary" target="_self"><h3>Internship Opportunities</h3></a></div>
<div><a id="sublink12" href="http://www.migrantstudents.org/careeropportunities.html" class="tertiary" target="_self"><h3>Career Opportunities</h3></a></div>
<div><a id="sublink13" href="http://www.migrantstudents.org/calendarofevents.html" class="tertiary" target="_self"><h3>Calendar of Events</h3></a></div>
<div><a id="sublink14" href="http://www.migrantstudents.org/communitypartners.html" class="tertiary" target="_self"><h3>Community Partners</h3></a></div>
<div><a id="sublink15" href="http://www.migrantstudents.org/corporatepartners.html" class="tertiary" target="_self"><h3>Corporate Partners</h3></a></div>
<div><a id="sublink16" href="http://www.migrantstudents.org/migrantedresources.html" class="tertiary" target="_self"><h3>Migrant Ed Resources</h3></a></div>
<div><a id="sublink17" href="http://www.migrantstudents.org/onlinestore.html" class="tertiary" target="_self"><h3>Online Store</h3></a></div>
<div><a id="sublink18" href="http://www.migrantstudents.org/onlinememberdirectory.html" class="tertiary" target="_self"><h3>Online Member Directory</h3></a></div>
<div><a id="sublink19" href="http://www.migrantstudents.org/donate.html" class="tertiary" target="_self"><h3>Donate</h3></a></div>
<div><a id="sublink20" href="http://www.migrantstudents.org/contactus.html" class="tertiary" target="_self"><h3>Contact Us</h3></a></div>
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<td colspan="" rowspan="" align="" valign="top" width="100%">
<div align="left"><br>
<table border="0" cellpadding="10" cellspacing="0" width="100%">
<tbody>
<tr>
<td align="middle" valign="top">
<form action="dynaform.php" method="post"><input value="gggalindo@adelphia.net" name="rec_mailto" type="hidden"> <input value="New Application" name="rec_subject" type="hidden"> <input value="thanks.php" name="rec_thanks" type="hidden">
<table style="border-collapse: collapse;" border="0" bordercolor="#111111" cellpadding="2" cellspacing="3" height="439" width="750">
<tbody>
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<td height="443" valign="top" width="96%">
<p align="center"><font face="Arial"><font size="4"><b>Online CAMPAA Student Info Request Form</b></font></font></p>
<p align="center"><b><font face="Arial">Over 2,500 Scholarships Awarded Every Year! <br></font></b><font face="Arial" size="2">Award amount may vary per CAMP campus and your financial need <br> </font></p>
<p align="left"><u><font face="Arial" size="2"><b>Eligibility Qualification: </b></font></u></p>
<p align="left"><font face="Arial" size="2"> Migrant or Seasonal farmworkers and/or their families working in agricultural activities directly related to <br> (1) the production of crops, dairy products, poultry or livestock; <br> (2) the cultivation or harvesting <br><br><u><b>Eligiblity Verification: </b></u></font></p>
<p align="left"><font face="Arial" size="2"> • Verfication
that they have participated during high school or are eligible to
participate in a Title 1 - Migrant Education Program as documented by a
Certification of Eligibility (COE) or</font></p>
<p align="left"><font face="Arial" size="2"> • Verfication
that they have participated or are eligible to participate in the WIA
(Workforce Investment Act) program by a Certification of Eligibility
(COE) or</font></p>
<p align="left"><font face="Arial" size="2"> • Verification
that they or their parents have spent a minimum of 75 days during the
past 24 months as a migrant and/or seasonal (not year-round) farmworker
as their ‘primary employment’ and must<br>
o Plan to enroll in college for the purpose of completing a bachelor’s
degree (BA/BS) <br>
o Be a U.S. citizen or will have permanent resident status by upon date
of school enrollment.<br>
o Have the need for CAMP support services, academic and financial
assistance. <br>
o Freshman credit level as determined by college (only 1st-year college
students may apply).<br> o Attend a CAMP campus. </font></p></td></tr>
<tr>
<td height="35" valign="top" width="96%"><b><font face="Arial">ALL INFORMATION IS REQUIRED</font></b></td></tr></tbody></table>
<center></center>
<table style="border-collapse: collapse;" border="0" bordercolor="#111111" cellspacing="0" height="10" width="750">
<tbody>
<tr>
<td align="right" height="22" width="100"><font face="Arial" size="2"> First Name:</font></td>
<td align="left" height="22" valign="center" width="638"><font face="Arial"><input style="background-color: rgb(179, 225, 179);" size="25" name="First_Name"><font size="2"> Last Name:</font><input style="background-color: rgb(179, 225, 179);" size="26" name="Last_Name"></font></td>
<td height="22" valign="center" width="7"> </td></tr>
<tr>
<td align="right" height="20" width="100"><font face="Arial" size="2"> Address:</font></td>
<td align="left" height="20" valign="center" width="638"><font face="Arial"><input style="background-color: rgb(179, 225, 179);" size="30" name="Address"><font size="2"> City:</font><input style="background-color: rgb(179, 225, 179);" size="26" name="City"><font size="2"> </font></font></td>
<td height="20" width="7"> </td></tr>
<tr>
<td align="right" height="20" width="100"><font face="Arial" size="2">State:</font></td>
<td align="left" height="20" valign="center" width="638"><select style="background-color: rgb(179, 225, 179);" size="1" name="us_states"> <option value="AL" selected="selected">AL Alabama</option> <option value="AK">AK Alaska</option> <option value="AZ">AZ Arizona</option> <option value="AR">AR Arkansas</option> <option value="CA">CA California</option> <option value="CO">CO Colorado</option> <option value="CT">CT Connecticut</option> <option value="DE">DE Delaware</option> <option value="DC">DC District of Columbia</option> <option value="FL">FL Florida</option> <option value="GA">GA Georgia</option> <option value="HI">HI Hawaii</option> <option value="ID">ID Idaho</option> <option value="IL">IL Illinois</option> <option value="IN">IN Indiana</option> <option value="IA">IA Iowa</option> <option value="KS">KS Kansas</option> <option value="KY">KY Kentucky</option> <option value="LA">LA Louisiana</option> <option value="ME">ME Maine</option> <option value="MD">MD Maryland</option> <option value="MA">MA Massachusetts</option> <option value="MI">MI Michigan</option> <option value="MN">MN Minnesota</option> <option value="MS">MS Mississippi</option> <option value="MO">MO Missouri</option> <option value="MT">MT Montana</option> <option value="NE">NE Nebraska</option> <option value="NV">NV Nevada</option> <option value="NH">NH New Hampshire</option> <option value="NJ">NJ New Jersey</option> <option value="NM">NM New Mexico</option> <option value="NY">NY New York</option> <option value="NC">NC North Carolina</option> <option value="ND">ND North Dakota</option> <option value="OH">OH Ohio</option> <option value="OK">OK Oklahoma</option> <option value="OR">OR Oregon</option> <option value="PA">PA Pennsylvania</option> <option value="RI">RI Rhode Island</option> <option value="SC">SC South Carolina</option> <option value="SD">SD South Dakota</option> <option value="TN">TN Tennessee</option> <option value="TX">TX Texas</option> <option value="UT">UT Utah</option> <option value="VT">VT Vermont</option> <option value="VA">VA Virginia</option> <option value="WA">WA Washington</option> <option value="WV">WV West Virginia</option> <option value="WI">WI Wisconsin</option> <option value="WY">WY Wyoming</option></select> <font face="Arial"><font size="2"> Zip:</font><input style="background-color: rgb(179, 225, 179);" size="7" name="Zip_code"></font></td>
<td height="20" width="7"> </td></tr>
<tr>
<td align="right" height="22" width="100"><font face="Arial" size="2"> Phone: </font></td>
<td align="left" height="22" valign="center" width="638"><font face="Arial"><input style="background-color: rgb(179, 225, 179);" size="19" name="Phone"></font></td>
<td height="22" valign="center" width="7"> </td></tr>
<tr>
<td align="right" height="22" width="100"><font face="Arial" size="2"> Email:</font></td>
<td align="left" height="22" valign="center" width="638"><font face="Arial"><input style="background-color: rgb(179, 225, 179);" size="30" name="Email"></font></td>
<td height="22" valign="center" width="7"> </td></tr>
<tr>
<td align="right" height="22" width="100"><font face="Arial" size="2">High School:</font></td>
<td align="left" height="22" valign="center" width="638"><font face="Arial"><input style="background-color: rgb(179, 225, 179);" size="30" name="High_School"><font size="2"> Grad Year:</font></font><select style="background-color: rgb(179, 225, 179);" size="1" name="Grad Date"> <option selected="selected">Select One</option> <option value="2004">2004</option> <option value="2005">2005</option> <option value="2006">2006</option> <option value="2007">2007</option> <option value="2008">2008</option></select><font face="Arial" size="2"> </font></td>
<td height="22" valign="center" width="7"></td></tr>
<tr>
<td align="right" height="22" width="100"><font face="Arial" size="2"> GPA:</font></td>
<td align="left" height="22" valign="center" width="638"><font face="Arial"><input style="background-color: rgb(179, 225, 179);" size="6" name="GPA"><font size="2"> Date of Birth:</font><input style="background-color: rgb(179, 225, 179);" size="11" name="Date_of_Birth"> <font size="2">(dd/mm/yy)</font></font></td>
<td height="22" valign="center" width="7"></td></tr>
<tr>
<td colspan="3" height="21" valign="center" width="801"> </td></tr>
<tr>
<td colspan="3" height="27" valign="center" width="801"><font face="Arial" size="2">What are you interested in studying (Major)?</font><font face="Arial"><font size="2"> </font><input style="background-color: rgb(179, 225, 179);" size="53" name="Major"></font></td></tr>
<tr>
<td colspan="3" height="34" valign="center" width="801"><font face="Arial"><font size="2">What semester are you interested in starting college? </font></font><select style="background-color: rgb(179, 225, 179);" size="1" name="College_Start_Date"> <option selected="selected">Select One</option>
<option value="Fall 07">Fall 07</option>
<option value="Winter 07">Winter 07</option>
<option value="Spring 08">Spring 08</option>
<option value="Fall 08">Fall 08</option>
</select></td></tr>
<tr>
<td colspan="3" height="16" width="801"></td></tr>
<tr>
<td colspan="3" height="22" width="801"><b><font face="Arial" size="2">My eligibility will be based on: (check one)</font></b></td></tr>
<tr>
<td colspan="3" height="20" width="801"><font face="Arial"><input value="ON" name="Migrant_Education_Program" type="checkbox"><font size="2">Migrant Education Program (MEP)</font></font></td></tr>
<tr>
<td colspan="3" height="20" width="801"><font face="Arial"><input value="ON" name="Workforce_Investment_Act" type="checkbox"><font size="2">Workforce Investment Act (WIA)</font></font></td></tr>
<tr>
<td colspan="3" height="20" width="801"><font face="Arial"><input value="ON" name="C2" type="checkbox"><font size="2">Migrant or Seasonal Farmworking Background</font></font></td></tr>
<tr>
<td colspan="3" height="9" width="801"></td></tr>
<tr>
<td colspan="3" height="161" width="1031"><b><font face="Arial" size="2">You may request to have your contact information sent up to (3) campuses:</font></b>
<p><font face="Arial"><font size="2">1. </font><select style="background-color: rgb(179, 225, 179);" name="First_college_Choice"> <option value="Select One" selected="selected">Your First Choice....</option> <option value="CA CSU, Sacramento">CA CSU, Sacramento</option> <option value="CA Mendocino Community College">CA Mendocino Community College</option> <option value="CA CSU, Bakersfield">CA CSU, Bakersfield</option> <option value="CA CSU, Long Beach">CA CSU, Long Beach</option> <option value="CA CSU, Monterrey Bay">CA CSU, Monterrey Bay</option> <option value="CA CSU, San Marcos">CA CSU, San Marcos</option> <option value="CA Sonoma State University">CA Sonoma State University</option> <option value="CA West Hills Community College">CA West Hills Community College</option> <option value="CO University of Colorado">CO University of Colorado</option> <option value="FL Barry University">FL Barry University</option> <option value="FL University of South Florida">FL University of South Florida</option> <option value="GA Abraham Baldwin Agricultural College">GA Abraham Baldwin Agricultural College</option> <option value="ID Boise State University">ID Boise State University</option> <option value="ID Lewis-Clark State College">ID Lewis-Clark State College</option> <option value="ID University of Idaho">ID University of Idaho</option> <option value="KS University of Kansas">KS University of Kansas</option> <option value="MI Michigan State University">MI Michigan State University</option> <option value="MO Crowder College">MO Crowder College</option> <option value="MS Mississippi Valley State University">MS Mississippi Valley State University</option> <option value="NM New Mexico Highlands University">NM New Mexico Highlands University</option> <option value="NM New Mexico State University">NM New Mexico State University</option> <option value="NM Northern New Mexico Community College">NM Northern New Mexico Community College</option> <option value="NM University of New Mexico">NM University of New Mexico</option> <option value="NY State University of New York">NY State University of New York</option> <option value="OH Ohio State University">OH Ohio State University</option> <option value="OR Oregon State University">OR Oregon State University</option> <option value="OR Chemeketa Community College">OR Chemeketa Community College</option> <option value="PN The Pennsylvania State University">PN The Pennsylvania State University</option> <option value="PR American University of Puerto Rico">PR American University of Puerto Rico</option> <option value="TX St. Edwards University">TX St. Edwards University</option> <option value="TX Our Lady of the Lake University">TX Our Lady of the Lake University</option> <option value="TX Texas A&M International University at Laredo">TX Texas A&M International University at Laredo</option> <option value="TX Texas State Technical College">TX Texas State Technical College</option> <option value="TX University of Texas at Brownsville">TX University of Texas at Brownsville</option> <option value="TX University of Texas at El Paso">TX University of Texas at El Paso</option> <option value="TX University of Texas - PanAmerican">TX University of Texas - PanAmerican</option> <option value="TX West Texas A&M">TX West Texas A&M</option> <option value="TX Texas A&M University, Kingsville">TX Texas A&M University, Kingsville</option> <option value="WA Heritage College ">WA Heritage College</option> <option value="WA Central Washington University">WA Central Washington University</option> <option value="WA Columbia Basin Community College">WA Columbia Basin Community College</option> <option value="WA Eastern Washington University">WA Eastern Washington University</option> <option value="WA Washington State University">WA Washington State University</option><option value="WI Milwaukee Area Technical College">WI Milwaukee Area Technical College</option> <option value="AR University of Arkansas">AR University of Arkansas</option> <option value="CA CSU, Fresno">CA CSU, Fresno</option></select></font></p>
<p><font face="Arial"><font size="2">2. </font><select style="background-color: rgb(179, 225, 179);" name="Second_college_Choice"> <option value="Select One" selected="selected">Your Second Choice....</option> <option value="CA CSU, Sacramento">CA CSU, Sacramento</option> <option value="CA Mendocino Community College">CA Mendocino Community College</option> <option value="CA CSU, Bakersfield">CA CSU, Bakersfield</option> <option value="CA CSU, Long Beach">CA CSU, Long Beach</option> <option value="CA CSU, Monterrey Bay">CA CSU, Monterrey Bay</option> <option value="CA CSU, San Marcos">CA CSU, San Marcos</option> <option value="CA Sonoma State University">CA Sonoma State University</option> <option value="CA West Hills Community College">CA West Hills Community College</option> <option value="CO University of Colorado">CO University of Colorado</option> <option value="FL Barry University">FL Barry University</option> <option value="FL University of South Florida">FL University of South Florida</option> <option value="GA Abraham Baldwin Agricultural College">GA Abraham Baldwin Agricultural College</option> <option value="ID Boise State University">ID Boise State University</option> <option value="ID Lewis-Clark State College">ID Lewis-Clark State College</option> <option value="ID University of Idaho">ID University of Idaho</option> <option value="KS University of Kansas">KS University of Kansas</option> <option value="MI Michigan State University">MI Michigan State University</option> <option value="MO Crowder College">MO Crowder College</option> <option value="MS Mississippi Valley State University">MS Mississippi Valley State University</option> <option value="NM New Mexico Highlands University">NM New Mexico Highlands University</option> <option value="NM New Mexico State University">NM New Mexico State University</option> <option value="NM Northern New Mexico Community College">NM Northern New Mexico Community College</option> <option value="NM University of New Mexico">NM University of New Mexico</option> <option value="NY State University of New York">NY State University of New York</option> <option value="OH Ohio State University">OH Ohio State University</option> <option value="OR Oregon State University">OR Oregon State University</option> <option value="OR Chemeketa Community College">OR Chemeketa Community College</option> <option value="PN The Pennsylvania State University">PN The Pennsylvania State University</option> <option value="PR American University of Puerto Rico">PR American University of Puerto Rico</option> <option value="TX St. Edwards University">TX St. Edwards University</option> <option value="TX Our Lady of the Lake University">TX Our Lady of the Lake University</option> <option value="TX Texas A&M International University at Laredo">TX Texas A&M International University at Laredo</option> <option value="TX Texas State Technical College">TX Texas State Technical College</option> <option value="TX University of Texas at Brownsville">TX University of Texas at Brownsville</option> <option value="TX University of Texas at El Paso">TX University of Texas at El Paso</option> <option value="TX University of Texas - PanAmerican">TX University of Texas - PanAmerican</option> <option value="TX West Texas A&M">TX West Texas A&M</option> <option value="TX Texas A&M University, Kingsville">TX Texas A&M University, Kingsville</option> <option value="WA Heritage College ">WA Heritage College</option> <option value="WA Central Washington University">WA Central Washington University</option> <option value="WA Columbia Basin Community College">WA Columbia Basin Community College</option> <option value="WA Eastern Washington University">WA Eastern Washington University</option><option value="WA Washington State University">WA Washington State University</option> <option value="WI Milwaukee Area Technical College">WI Milwaukee Area Technical College</option> <option value="AR University of Arkansas">AR University of Arkansas</option> <option value="CA CSU, Fresno">CA CSU, Fresno</option></select></font></p>
<p><font face="Arial"><font size="2">3. </font><select style="background-color: rgb(179, 225, 179);" name="Third_college_Choice"> <option value="Select One" selected="selected">Your Third Choice....</option> <option value="CA CSU, Sacramento">CA CSU, Sacramento</option> <option value="CA Mendocino Community College">CA Mendocino Community College</option> <option value="CA CSU, Bakersfield">CA CSU, Bakersfield</option> <option value="CA CSU, Long Beach">CA CSU, Long Beach</option> <option value="CA CSU, Monterrey Bay">CA CSU, Monterrey Bay</option> <option value="CA CSU, San Marcos">CA CSU, San Marcos</option> <option value="CA Sonoma State University">CA Sonoma State University</option> <option value="CA West Hills Community College">CA West Hills Community College</option> <option value="CO University of Colorado">CO University of Colorado</option> <option value="FL Barry University">FL Barry University</option> <option value="FL University of South Florida">FL University of South Florida</option> <option value="GA Abraham Baldwin Agricultural College">GA Abraham Baldwin Agricultural College</option> <option value="ID Boise State University">ID Boise State University</option> <option value="ID Lewis-Clark State College">ID Lewis-Clark State College</option> <option value="ID University of Idaho">ID University of Idaho</option> <option value="KS University of Kansas">KS University of Kansas</option> <option value="MI Michigan State University">MI Michigan State University</option> <option value="MO Crowder College">MO Crowder College</option> <option value="MS Mississippi Valley State University">MS Mississippi Valley State University</option> <option value="NM New Mexico Highlands University">NM New Mexico Highlands University</option> <option value="NM New Mexico State University">NM New Mexico State University</option> <option value="NM Northern New Mexico Community College">NM Northern New Mexico Community College</option> <option value="NM University of New Mexico">NM University of New Mexico</option> <option value="NY State University of New York">NY State University of New York</option> <option value="OH Ohio State University">OH Ohio State University</option> <option value="OR Oregon State University">OR Oregon State University</option> <option value="OR Chemeketa Community College">OR Chemeketa Community College</option> <option value="PN The Pennsylvania State University">PN The Pennsylvania State University</option> <option value="PR American University of Puerto Rico">PR American University of Puerto Rico</option> <option value="TX St. Edwards University">TX St. Edwards University</option> <option value="TX Our Lady of the Lake University">TX Our Lady of the Lake University</option> <option value="TX Texas A&M International University at Laredo">TX Texas A&M International University at Laredo</option> <option value="TX Texas State Technical College">TX Texas State Technical College</option> <option value="TX University of Texas at Brownsville">TX University of Texas at Brownsville</option> <option value="TX University of Texas at El Paso">TX University of Texas at El Paso</option> <option value="TX University of Texas - PanAmerican">TX University of Texas - PanAmerican</option> <option value="TX West Texas A&M">TX West Texas A&M</option> <option value="TX Texas A&M University, Kingsville">TX Texas A&M University, Kingsville</option> <option value="WA Heritage College ">WA Heritage College</option> <option value="WA Central Washington University">WA Central Washington University</option> <option value="WA Columbia Basin Community College">WA Columbia Basin Community College</option> <option value="WA Eastern Washington University">WA Eastern Washington University</option><option value="WA Washington State University">WA Washington State University</option> <option value="WI Milwaukee Area Technical College">WI Milwaukee Area Technical College</option> <option value="AR University of Arkansas">AR University of Arkansas</option> <option value="CA CSU, Fresno">CA CSU, Fresno</option></select></font></p></td></tr></tbody></table>
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