C.A.M.P Eligibility Verification Form of Seasonal Work (2025)

CAMP Eligibility Verification Form of Seasonal Work
In order to be eligible for services provided by the Heritage University College Assistance Migrant Program (CAMP) under the guidelines established by the U.S. Department of Education;
- a student and/or their immediate family member (spouse, parent, guardian, sibling, etc.)
- any person who claims them as a dependent on a Federal Income Tax return
- any person in the same household, as the prospective CAMP student, that supports that student financially and is a relative.
Must have worked at least 75 days within the last 24 months in agriculture as a seasonal or migrant laborer.

This includes any activity directly related to the production of crops, dairy products, poultry, livestock, cultivation or harvesting of trees, ranching, fishery, nursery and forestry work. For pay or for self-subsistence.
Student's First and Last Name*

First NameLast Name
Student Phone Number*
Please enter a valid phone number.
Name of Employee who performed agricultural work*

First NameLast Name
Phone Number of Employee*
Please enter a valid phone number.
Relationship to Student*

Employment History*

	Name of their Employer	Type of work performed	What product were you working with?	Dates of Employment	Contact Person from Site	Contact person phone number
1
2
3
4
5

Please upload proof of 75 days of continued eligible work within the last 24 months. *

You can provide this by making copies or taking pictures of your or a fellow household members W-2 forms and/or paystubs.
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This section is to be electronically signed by the student or immediate family member, who meets the requirements and is applying to the College Assistance Migrant Program (CAMP) at Heritage University. *

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