VTEA (Vocational and Technical Education Act) 
Student Information Survey

NOTE:

1) Your responses are completely confidential.

2) You responses will help determine the amount of funding Barstow Community College receives for its Vocational Programs. THANK YOU FOR YOUR HELP!

Name:

Email:

Male Female

Last four numbers of Student ID

PhonePlease use this format (xxx)xxx-xxxx

Street Address
City, State Zip

I am enrolled/will enroll in a vocational class for: Spring Summer Fall semester, 
year 20: (SV01)

Accounting

Admin. of Justice

Air Conditioning

Allied Health

Automotive 

Business Admin.

Business Tech.

Cosmetology

Computer Science

Drafting

Early Childhood Ed.

Electronics

Fire Science 

Home Economics

Library Science

Management 

Photography 

Real Estate 

Work Experience 

Welding

I am currently receiving the following services/assistance: (SV02)

Book loan Child care Counseling Transportation Tutor/reader

I would like to receive more information and/or contact regarding the following services/assistance: (SV02)

Book loan Child care Counseling Transportation Tutor/reader

Check the box which shows your total yearly household income 
(This information will remain confidential)

$15,600 or less (SV03) $26,400 - $31,800 $42,600 - $48,000
$15,600 - $21,000 $31,800- $37,200 $48,000 - $53,400
$21,000 - $26,400 $37,200 - $42,600  

How many individuals are in your household? 

1 person 3 people 5 people 7 people
2 people 4 people 6 people 8 or more

Check all of the following which apply to you:

AFDC (SV03) Learning Disabled GAIN (SV03) PELL (SV03)
SSI (SV03) Displaced worker* JTPA (SV03) Veteran
Gen. Asstc. (SV03) BOGW (SV03) Physically Disabled Tech. Prep.(SV08)
Single parent living with child (SV04)  First Generation College Student
Co-op Work Experience (SV07)

Displaced Homemaker (SV05)+

Migrant Worker Status (SV09) Migrant Worker Dependent Status (SV09)

* Displaced Worker = Job eliminated due to downsizing, mechanization, etc.
+
Displaced Homemaker = Divorced, death in family, etc.

HAVE YOU APPLIED FOR A FEE WAIVER?

You may be eligible for a fee waiver (BOGW Grant). To find out if you qualify, fill out a BOGW application, which is available from the Financial Aid Office.

THANK YOU FOR YOUR HELP!

Your responses will help determine the amount of funding
 Barstow Community College receives for its vocational programs.