TRiO Educational Opportunity Center Application
Today's Date:
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Month
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Day
Year
Date
Name:
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First Name
Middle Initial
Last Name
Date of Birth:
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Month
-
Day
Year
Date
Age:
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Gender:
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Mailing Address
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City
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State
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Zip Code
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Email Address
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Telephone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Are you a current participant of another federally funded program?
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Yes
No
Which federally funded program do you participate in?
Are you a U.S. Citizen or a Permanent Resident?
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Yes
No
Is English your first language?
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Yes
No
Please select your race (For Reporting Purposes Only):
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Hispanic or Latino
American Indian or Alaska Native
Asian
Native Hawaiian or Other Pacific Islander
Caucasian or White
Black or African-American
Military Connected Status:
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No Military Connection
Veteran
Active Duty
Reserve/Guard
Dependent Child of Veteran
Dependent Child of Active Duty
Dependent Child of Reserve/Guard
Dependent Spouse of Veteran
Dependent Spouse of Active Duty
Dependent Spouse of Reserve/Guard
Marital status?
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Single
Married
Divorced
Separated
Widowed
Do you have children or dependents whom you provide more than 50% support?
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Yes
No
How many live in your household?
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Does either of your parents have a bachelor's degree?
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Yes
No
Family’s taxable income level (Line 15 of tax return form 1040):
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Option 1: 0 - $23,940
Option 2: $23,941 - $32,460
Option 3: $32,461 - $40,980
Option 4: $40,981 - $49,500
Option 5: $49,501 - $58,020
Option 6: $58,021 - $66,540
Option 7: $66,541 - $75,060
Option 8: $75,061 - $83,580
Option 9: Above $83,581
Please indicate your current level of education below (choose one):
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High School Senior
Enrolled in GED
High School or GED graduate
Did not complete High School, not in GED
Currently enrolled in college or technical school
Attended college or tech school but did not complete
Associate's degree or certificate
Bachelor's degree or higher
Which high school do you attend?
How can we help you today? (mark all that apply)
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FAFSA/financial aid
College or technical school applications
College or technical school search
Academic test prep
Career interest assessment
Financial Literacy
GED programs
Other
Acknowledgement
My signature below certifies that the above information is correct. It also serves as consent for my records (transcripts, financial aid awards and information, test scores, as well as any information provided to National Student Clearinghouse) to be released to the Federal TRIO program(s) that I am a member of (Educational Opportunity Center) from Carl Albert State College for the specific purposes of tracking which allows the Federal TRIO programs to follow my college career. I understand that this is information that is required for their grants and I am consenting that such information be shared with them.l understand that EOC will contact me upon receipt of my application to obtain additional information and/or provide services and resources including financial literacy information.Regarding FAFSA Assistance: I also acknowledge that although EOC provides FAFSA assistance, the program is not part of the financial. aid office at my institution Therefore it is my responsibility to adhere to FAFSA guidelines. This includes providing accurate and complete information on the FAFSA application. I understand EOC is not responsible or liable for required information that is reported incorrectly or undisclosed. Once the FAFSA has been completed it is also my responsibility to follow up with my institution to complete additional forms to complete the financial aid process.
Signature:
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Parent/Guardian Signature:
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