Previous Education

Educational Goals

Name of Adults in the home (including yourself)

Names of Children in the home:

If yes, complete the section below. If no, skip to the next question

Complete section below only if applying for CalWORKs/CARE

I authorize the Department of Social Service to release or exchange information with the Yuba College CalWORKs/CARE Program. I authorize the Yuba College CalWORKs/CARE Program to release or exchange information with Yuba College Student Services Programs. I understand that if I utilize the Yuba College CalWORKs Job Placement Services, my information may be exchanged with potential employers. I understand that my attendance and progress will be monitored, tracked and release to my CalWORKs Caseworker/ Representative or Designee of the County Department of Social Services. I authorize the Yuba College CalWORKs/ CARE Program to discuss circumstances as they relate to my educational program and attendance with the Department of Social Services as well as my Yuba Community College District professors. I understand that if I do not bring in a Passport-to-Services (CalWORKs/CARE Eligibility) each semester, I will no be able to meet with the CalWORKs counselor or receive services.
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