Award Application

ESL Halderman Award

Application
Due Date:______________

Name_________________________________________________________ Date________________

Social Security Number_______________________________________ Phone Number_____________

Home Address_______________________________________________________________________________

Winning recipients must write a brief "thank you" response letter. For questions, please contact Douglas Pillsbury at 546-3941 or Anthony Halderman at 591-6254

Please answer the following questions completely and honestly.

1) How many semesters have you completed at Cuesta College? 1 2 3 4 5 6 7 8

2) What were your grades in your Fall ESL class(es)? For new students, what are your current grades?

3) What is your current ESL class level? 1 2 3 4 5
What is your teacher's name? __________________________________________________________

4) What is your educational goal?

5) Briefly describe how Cuesta has helped you with this goal.

Check the Cuesta services you have used.
____Career Counseling _____EOPS _____Financial Aid

____Health Services ____Learning Assistance Center

____Personal Counseling _____ Tutoring _____Children's Center

6)How have you used the English you've leaned at Cuesta in your everyday life?

7)Do you qualify as a Board of Governors Fee Waiver (BOGW) recipient under program A or B? Yes___No____

8)Do you work outside your home for payment (money)? Yes___No____

9)How many hours do you work per week?____________

10) How many children under the age of 18 are living with you?_________________________