Forms - CalWORKs
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ECC CalWORKs FORMS 


Below are various forms provided by ECC CalWORKs program.   Please read the description under each form title to help you select the correct document(s).  Print out the forms you need, and complete them in blue or black ink ONLY.  Completed forms must be returned to the CalWORKs office located at SSVC-205B.   If you have any questions please contact us at (310) 660-6057. 

 

Daisey Viera Application

Daisy Viera Grant Application

In memory of CARE & CalWORKs student Daisy Viera and her dedication and service to others, 2 CARE and/or CalWORKs students will be awarded with $250 grant and recognized at the 22nd Annual Recognition Banquet. Apply for the Daisy Viera Grant by April 12, 2019 by 1:00pm. See application for details.

 

Checklist

ECC CalWORKs Checklist

The Checklist form helps students track the steps required to enroll into the ECC CalWORKs Program and to learn the services provided from our staff.

  

Intake Form

ECC CalWORKs Intake Process Form

The Intake Process form provides to the ECC CalWORKs program all information required to create student record  for data entry.

 

Book Request

ECC CalWORKs - GAIN Book Request Form

The GAIN Book Request form allows students to submit Books, Supplies and Fees related to the term in session.

 

Su18 VoB

ECC CalWORKs Verification of Benefits Form (VOB)

Each semester, CalWORKs Students are required to turn in a Verification of Benefits completed either by an Eligibility or GAIN worker to verify eligibility and to stay in compliance with the ECC CalWORKs program. A Your Benefits Now (YBN) printout may also be submitted to the CalWORKs Office to fulfill this requirement.

 

Update Form

ECC CalWORKs Student Update Form

New and continuing students must complete the Student Update Form each semester/term. This form will help us keep the students information up-to-date.

    


CalWORKs Flyer

        ECC CalWORKs Flyer  

The goal of CalWORKs is to help eligible students obtain degrees and certificates while gaining work experience leading to sustainable employment.

 

The GAIN forms below are completed by the ECC CalWORKs office after   
the 
GAIN Services Worker (GSW) issues them to the participant.  

  • GN 6005A (Self Initiated Program)

  • GN 6006 (Vocational) along with GN 6013 and GN 6014

  • GN 6390 (Attending Multiple Schools) along with GN 6013 and GN 6014

  • GN 6070 (Progress Report)

  • ST1-20A (WTW Verification) Training Verification 

 

 *** All paper work takes three business days to be completed ***