EOC Application

TRiO Educational Opportunity Center Application
Today's Date:*

MonthDayYear
Date
Name:*

First NameMiddle InitialLast Name
Date of Birth:*

MonthDayYear
Date
Age:*
Gender:*
Mailing Address*
City*
State*
Zip Code*
Email Address*
Telephone Number*
Please enter a valid phone number.
Are you a current participant of another federally funded program?*

YesNo
Which federally funded program do you participate in?
Are you a U.S. Citizen or a Permanent Resident?*

YesNo
Is English your first language?*

YesNo
Please select your race (For Reporting Purposes Only):*

Hispanic or LatinoAmerican Indian or Alaska NativeAsianNative Hawaiian or Other Pacific IslanderCaucasian or WhiteBlack or African-American
Military Connected Status:

No Military ConnectionVeteranActive DutyReserve/GuardDependent Child of VeteranDependent Child of Active DutyDependent Child of Reserve/GuardDependent Spouse of VeteranDependent Spouse of Active DutyDependent Spouse of Reserve/Guard
Marital status?*

SingleMarriedDivorcedSeparatedWidowed
Do you have children or dependents whom you provide more than 50% support?*

YesNo
How many live in your household?*
Does either of your parents have a bachelor's degree?*

YesNo
Family’s taxable income level (Line 15 of tax return form 1040):*

Option 1: 0 - $23,475Option 2: $23,476 - $31,725Option 3: $31,726 - $39,975Option 4: $39,976 - $48,225Option 5: $48,226 - $56,475Option 6: $56,476 - $64,725Option 7: $64,726 - $72,975Option 8: $72,976 - $81,225Option 9: Above $81,225
Please indicate your current level of education below (choose one):*

High School SeniorEnrolled in GEDHigh School or GED graduateDid not complete High School, not in GEDCurrently enrolled in college or technical schoolAttended college or tech school but did not completeAssociate's degree or certificateBachelor's degree or higher
Which high school do you attend?
How can we help you today? (mark all that apply)*

FAFSA/financial aidCollege or technical school applicationsCollege or technical school searchAcademic test prepCareer interest assessmentFinancial LiteracyGED programsOther
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: Click here to sign*
Parent/Guardian Signature: Click here to sign Date
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TRiO Educational Opportunity Center Application