Owens State Community College-EOC-2024 Application Form

Per the Family Educational Rights and Privacy Act (FERPA), information in this application is confidential - we will protect your sensitive personal data. Incomplete applications may be returned to you or rejected.

Full Name:*

First NameMiddle InitialLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SOCIAL SECURITY NUMBER:*

999-99-9999

Date of Birth

mm-dd-yyyy

Email:*

example@example.com

Phone Number

(999)999-9999

Please check the box for the phone number your entered above:

MobileLandline

Does this phone number support text messaging?

YesNo

How would you like us to contact you?

Phone callEmailText messages

U.S. CITIZEN or PERMANENT RESIDENT?*

YesNo

IS ENGLISH YOUR PRIMARY LANGUAGE?*

YesNo

U.S. MILITARY VETERAN:*

YesNo

GENDER:*

FEMALEMALE

RACE*

Size of your family household*

Family Taxable Income*

Did either of your parent (s) or legal guardians complete a 4-year (bachelor) degree program?*

YesNoI was/am foster care youthNeither parent was involved in my life

What is your current level of education?*

I AM INTERESTED IN:*

I authorize the exchange of information between the Educational Opportunity Center (EOC) and other agencies, as necessary to assist me in achieving my educational goals. By signing and submitting this application, I certify that the information provided is complete and correct in every respect.

Name*

First NameLast Name

Signature:*

Date

mm-dd-yyyy

EOC 2024 Application Form