Golden West College eCounseling Form

Fields marked with an * are required.


First Name:	*
Last Name:	*
Student ID:
	Please use your 8-digit ID not your Social Security Number.
Birthdate:
Telephone:	-
Email address:	*

Are you currently an enrolled Golden West College student: yes no
Check all that apply: Enrolled in an online course International Student [F-1 visa] CalWORKs/Re-Entry EOPS Disabled Students Student Athlete Have you attended other colleges/universities? yes no If you answered 'yes', are your transcripts on file with the Admissions & Records office? yes no What is your major? Educational Objective: Certificate Associate Degree Transfer Other (please specify ): What is your career goal? Please submit your question to an online counselor:* (click on the "submit" button below when you are through)

You are submitting a form which is not secure. The information you are sending can be read while
in transit. Please be note that submitting passwords, credit card numbers, or SS#'s is not advised.