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IMPORTANT
GCC responds to the Coronavirus Outbreak. GCC has moved to remote online instruction.

Intake Form

Please correct the field(s) marked in red below:

First Name
 *
Last Name
 *
Phone Number
 *
Birth Date *  MM/DD/YYYY
 *
Mailing address/or Forwarding Address:
 *
Mailing address/or Forwarding Address:
What is your email address?
Which semesters do you wish to attend Glendale Community College?
 *
Which semesters do you wish to attend Glendale Community College?
Which of these apply to you?
Which of these apply to you?
If you are currently incarcerated, what is your expected release date and county of parole?
 *
Do you need any of the following?
Do you need any of the following?
Do you need to register with law enforcement authorities or any registry?
Do you need to register with law enforcement authorities or any registry?
Do you have any below?
 *
Do you have any below?
Have you previously attended any other colleges?
 *
Have you previously attended any other colleges?
What is your major? 
Have you completed any transferrable units?
 *
Have you completed any transferrable units?
Have you completed the financial aid (FAFSA) application?
Have you completed the financial aid (FAFSA) application?
Have you defaulted on student loans?
 *
Have you defaulted on student loans?
Have you completed the California Dream Act application?
Have you completed the California Dream Act application?
Do you have a valid California ID?
Do you have a valid California ID?
Do you have a valid California Drivers license?
Do you have a valid California Drivers license?
Do you have a vehicle?
Do you have a vehicle?
Do you need a transportation voucher?
Do you need a transportation voucher?
What is your Housing situation?
Do you receive Cal Fresh (Food stamps)?
Do you receive Cal Fresh (Food stamps)?
If No, Do you need help applying for Cal Fresh?
If No, Do you need help applying for Cal Fresh?
If you had access to mental health services, would you be interested in receiving information?
If you had access to mental health services, would you be interested in receiving information?
Do you have Medi-Cal or Medicare?
Do you have Medi-Cal or Medicare?

If you have any other concerns or comments feel free to respond below.

  1. To receive a copy of your submission, please fill out your email address below and submit.