Online Application Print Form Page

29/7/2014 Online Application Print Form Page

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Application ID: 90950626 Status = ActiveLegal Name: FERNANDO MELLO LEITE

Birth Date: 04/25/1991

E-Mail Address: [email protected]

This application is for: Spring 2015 at Mesa College

Local Mailing Address:

50 eight hundred street/Apt114

Number (or P.O. Box) Street/Apt. No.

Balneário Camboriú Brazil

City State Zip Code Country

Legal Address: Same as mailing address above

Home Phone: - - Work Phone: - -

Gender: Male

Citizenship: Other Status

When did your present stay In California Begin: 01/05/2015

Marital Status: Single

Major: English

Ethnic Background:

Are you Hispanic or Latino? Yes No

Select All That Apply:

Mexican, Mexican-American, Chicano

Central American

South American

Hispanic Other

What is your race/ethnicity?

Asian Indian

Asian Other

Chinese

Black or African American

Japanese

American Indian/Alaskan Native

Korean

Guamanian

Laotian

Hawaiian



Cambodian

Samoan

Vietnamese

Pacific Islander Other

Filipino

White

Residency Questions:

Obtained a driver's license No

Registered to vote No

Petitioned for divorce No

Attended an educational institution No

Filed state income taxes as a resident No

Registered a vehicle No

Claimed Leave and Earnings Statement (LES) No

Is English the language you Speak, Read, and Write most of the time: Yes

Employment Hours Per Week: 20 - 29

Are you currently enrolled in a degree program at a 4-year institution: Yes

Are you the first person in your family to attend college? No

U.S. Military Status:

Have you been active in the military within the last TWO YEARS?

Never in Military

Are you the dependent or spouse of active military personnel within the last TWO YEARS?

No

Dependents: None

Special Services:

Basic Skills Disable Student Services Transfer Services

Student Organizations Employment Assistance Tutoring

Career Planning Financial Aid Health Services

Child Care Learning Disabilities Legal Assistance

CalWORKS Learning English Language/ESL Community Service

Honors Program EOPS

Enrollment Status: Have only attended a college OTHER THAN San Diego City/Mesa/Miramar/ECC

The highest degree received: No Degree

High School

Graduation

Status:

Received Foreign Secondary School Diploma/Certificate of Graduation in 2008

High School G.P.A: Unkown

Select Last High School Attended: High School Outside The U.S.

Annual Family Income: 15K-15999



Educational Goal: Educational development (intellectual, cultural)

Colleges or Universities Attended:

Last College Attended

From: 01/2012 To: 12/2013

Out-Of-Country College: Brazil

I am a former or current Foster Youth, and am interested in financial aid and/or other benefits and

services available to Foster Youth: No

Within the past 5-years, have you ever been, or are you currently in the process of a formal expulsion

hearing from a California community college? No

If creating a new application and not providing an SSN, I

have affirmed that I: Do not have an SSN

Student Services

3375 Camino Del Rio, South

Suite 100 San Diego CA 92108

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