OCC Basics Needs Center Assistance Form

Who are you filling this form for?

I am filling this form for:

Myself

Another Student

Requester Information:

We'd like to know more information about the person making the request.

Full Name:

Email:

Department:

Relationship to Student:

Faculty

Staff

Peer/Friend

All information provided will remain confidential. However, if the student requests, may we disclose your identity?

Yes, you may share my identity with the student if they ask.

No, I prefer to remain anonymous.

The following section will be asking questions about the student you are making the request for.

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Student Information:

OCC Student ID: (example: C01234567)

First Name (Legal)

Preferred Name:

Last Name:

Email Address:

Date of Birth:

Student Pronouns:

He/him/his

She/her/hers

They/their/theirs

Other

Other:

Student Background Information:

Please select any of the options that applies to you:

Please select any of the resource programs in which you are currently participating or receiving services from:

Assistance Request:

I am requesting: (including the Hardship Grant, which will open the 3rd week of the main academic semester)

Basic Needs Assistance

Textbook Assistance

Basic Needs Assistance Assessment:

If you need other forms of assistance, please share below:

Hardship Grant Details:

*The Hardship Grant is available starting the 3rd week of each Fall and Spring semester. Eligible students can apply for the OCC Basic Needs Center Hardship Grant, which provides direct financial assistance to cover costs related to:

Academics
Child care
Food
Housing/living
Transportation

This grant is intended to support students facing unforeseen circumstances that disrupt their educational progress.

Important Additional Information:

The OCC Basic Needs Team will carefully review your application to better understand your situation and determine the most appropriate support. For information on eligibility deadlines, please visit the Basic Needs Center webpage.

I would like to apply for the Hardship Grant*

Please answer the following questions below to be consider for the Hardship Grant:

Please explain how the funding would be used to ease your financial situation and assist your academic success.

Describe in detail your current unforeseen hardship and how it disrupts your progress towards completing your educational goals at OCC. Please include as much detail as possible so we can understand your situation and make an informed decision about funding.

Transportation Resources:

Tell us more about your transportation situation:

I need a bus pass.

I have a car, drive to school, and need a parking permit.

I have a car, drive to school, and need a gas card.

Other (information shared here can be reviewed for Hardship Grant eligibility)

Other:

Food Resources:

Select all statements that apply to you.

More Information: The CalFresh Program, federally known as the Supplemental Nutrition Assistance Program (SNAP), issues monthly electronic benefits that can be used to buy most foods at markets and food stores.

If you are interested in applying, please make an appointment with a case manager for assistance.

Hygiene Resources:

What kind of hygiene resources would be helpful? Select all that apply.

I need full-size hygiene items.

I need travel size hygiene kit.

I need menstrual products.

I need access to a shower and locker room.

Parenting Resources:

What kind of child care resources and information would be helpful? Select all that apply.

Other:

Housing Resources:

Disclaimer: Housing is one of our most urgent needs, and we collaborate with community partners to assist students in finding housing. While we cannot guarantee immediate placement, we will do our best to connect you with available resources on and off campus.

Tell us more about your housing situation:

I am living in my car.

I am at risk of losing my housing.

I have temporary housing with a friend or family member.

Other (information shared here can be reviewed for Hardship Grant eligibility)

Other:

Health Resources:

What health resources and information would be helpful? Select all that apply.

I need a general health exam.

I need access to a mental health professional.

Tell Us More About Your Request:

Do you need support within the next 72 hours?
Note: This question does not apply to our hardship grant

Yes

No

About Textbook & Supply Assistance:

By submitting this form, currently enrolled students can request assistance with purchasing textbooks and supplies from the OCC Bookstore. To receive assistance, you need to meet the following criteria:

Enrolled in courses at OCC (this assistance cannot be used for Coastline College or Golden West College courses)
Receive the California College Promise Grant (CCPG) fee waiver
Not part of a program the provides participants with textbook assistance (i.e. EOPS/Care, Guardian Scholars, or Student Equity)

Students can receive the following amount of assistance:

Fall/Spring Semesters:
- 12 units or more at OCC = $300 for textbooks and/or $100 for supplies
- 9-11 units at OCC = $250 for textbooks and/or $75 for supplies
- 6-8 units at OCC = $200 for textbooks and/or $50 for supplies
- Less than 6 units at OCC = $150 for textbooks and/or $50 for supplies
Intersession:
- $150 for textbooks and/or $50 for supplies

Once your assistance request has been processed, you will receive a notice from the OCC Cares team that your OCC bookstore account is ready to be used. Funds for assistance are limited, and assistance is available on a first-come, first-served basis.

Please select the semester/session you are requesting assistance for:

Fall

Intersession/Winter

Spring

Select what you are requesting assistance with purchasing:

Textbooks

Supplies