Forms
How to:
Form Type and Description
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In-House
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LA County
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OC County
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---|---|---|---|
Attending Multiple Schools (GN6390): Form generated by county GAIN Service Worker for students attending 2 or more colleges/universities at the same time. | X | ||
Continuing Student Intake: Internal form required every semester along with County Approved Eligibility documentation
(Verification of Benefits Form or Notice of Action) to maintain current contact information
and keep students up to date with important changes or deadlines.
|
X | ||
Employment Verification (Work-Study): Form generated by county GAIN Service Worker to request verification of work-study
participation.
|
X | ||
Intake (GN6006)- Service Provider Referral: Must be signed and include GN6013 & GN6014 Vocational Assessment.
To fill out you MUST:
|
X | ||
Monthly Attendance Report (GN 6365): Form is generated by GAIN Case Worker and must be completed and submitted every month.
Due dates and deadlines are listed on form or provided by GAIN Case Worker.
|
X | ||
New Student Intake: Internal form utilized to verify and obtain student information for successful in-take
process.
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X | ||
Notice of Action: Form generated by GAIN Service Office which notifies students of changes related
to benefits.
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X | ||
Progress Report (GN 6070): Form generated and mailed to student by GAIN Service Worker.
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X | ||
Student Appeal: Internal form used for deferments, work-study verification letters or extension, and
requesting copies or requesting to resubmit documents to county workers.
|
X | ||
Verification of Welfare-To-Work Participation Hours (STI-20A): Form generated and mailed to student by GAIN Service Worker. Previously known as the
Training Verification or Child Care Form.
|
X | X | |
Verification of Benefits: County form that verifies CalWORKs eligibility.
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X | X | |
Verification of Receipt of CalWORKs: Generated by county case worker after requested by students.
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X | ||
Welfare-To-Work Attendance/Progress Report (41-06): Form generated and mailed to student by county service worker.
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X | ||
Welfare-To-Work Referral For Education/Training: Form generated and mailed to student by county service worker.
To fill out you MUST:
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X | ||
Work-In Progress (WIP): Internal form used to check student current course progress and must be completed
every semester. Form is available for pick-up, via our website, and also available
for download via Canvas.
Once form has been completed by instructors, students must sign it and can drop it
off in the CalWORKs office (no appointment needed), upload a copy via Canvas, or email
it to calworks-info@cerritos.edu. If taking online classes:
For students with courses where grade is below a “C”, a CalWORKs Counseling appointment
is required to discuss options and support services/interventions.
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X
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