OCC Cares Resource Request Form - Summer 2022


Please complete this request form to help the OCC Cares team know how we can support you.

This is a no-judgment zone. Your answers will only help us to best support you. Your responses will be kept confidential and will only be seen by the OCC Cares staff.

Depending on your answers and needs, we may reach out to you directly with support and resources. Submission of this form is not a guarantee of resources.

We are grateful for your time. If you have any questions, please email occcares@occ.cccd.edu

Student Information

Mailing Address*
May we text this number? *
Message and data rates may apply
What are your pronouns? *
Pronouns used to describe individuals in the discourse (e.g. she, him, they)
Are you a veteran student?
Are you an undocumented student?
Are you in need of a place to stay?
Where are you staying right now?*
Please select the option that best suits your situation. This is a no-judgement zone.

Basic & Essential Needs

Orange Coast College recognizes that basic and essential needs such as food, housing, health, family care, employment, and more are necessary for our students to be successful. For students with specific needs (such as veteran students or undocumented students), more specific support and resources might be needed.

Please answer the below questions to help us assess what kinds of resources and support we can provide to you during this time of transition.

Please select all methods of communication that you are able to receive.*
Please select all that work for you.
Which of the following resources would be helpful right now?
This is a no-judgment zone - we are here to help, so please mark the answers that best fits your situation.
Do you have a kitchen where you can cook?*
Please be exact - no ranges please.
What kind of Transportation Resource would be helpful?*
This is a no-judgement zone. All answers will only be used to determine how to assist you.

Optional Demographics Survey

Gender refers to the socially constructed characteristics of women and men, such as norms, roles, and relationships of and between groups of women and men. It varies from society to society and can be changed
A person's sexual identity in relation to the gender to which they are attracted
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