Marshall University-Heart Of Appalachia-EOC

Heart of Appalachia Educational Opportunity Center Application

Participant Information
Some things to help while completing this application:
1. All questions marked with an (*) must be answered to continue the application. If you choose to skip a question, you can discuss those with your counselor once you are contacted.
2. You must sign the application at the end using your computer touch pad, mouse, or touchscreen phone. It is a signature, not typed. After you sign, click the next button at bottom of page.
3. Even if you have done a paper application before, please complete the entire online application, so we make sure we have your updated information.
4. All information is strictly confidential and is kept in a secure manner. It is never shared with the public. All our services are free. We are a program funded by the U.S. Department of Education.
5. If you have any questions, contact us at eoc@marshall.edu
1. What is Today's Date?

MonthDayYear
mm-dd-yyyy
2. What is your name?*

First NameMiddle InitialLast Name
3. Maiden Name
4. What is your mailing address?*

Street Address Line 1

Street Address Line 2

CityState

Zip Code
Telephone numbers?
5. Cell Phone*
(999)999-9999
6. Home Phone*
(999)999-9999
7. Other*
(999)999-9999
8. May we send texts to your cell phone?

YesNo
9. What County do you live in?

Cabell CountyWayne CountyLincoln CountyMason CountyOther
10. What is your Email address? *
example@example.com
11. Do you have a Facebook Page?

YesNo
12. Have you been served by another federally funded program during the past year?

Talent SearchUpward BoundStudent Support ServicesVeterans Upward BoundNo
13. Social Security Number (xxxxxxxxx), If you are uncomfortable filling in your social security number, please skip this question. This information is only needed if we assist you in completing the Free Application for Federal Student Aid (FAFSA). It is not required to complete the application.
999-99-9999
14. What is your date of birth?*

MonthDayYear
mm-dd-yyyy
15. What is your gender?

MaleFemaleNonbinary/Not listed
16. Are you a U.S. citizen?

YesNoI am a permanent resident of the United States or can provide documentation from U.S. Immigration and Naturalization Service of my intent to become a permanent resident
17. Are you a member of the Military, or Military Family?

I am Currently Active Duty MilitaryI am a Honorably Discharged VeteranI am the Spouse of Active Duty MilitaryI am the child of Active Duty Military and under the age of 24No
18. What is your marital status?

SingleMarriedDivorcedLegally SeparatedWidowed
19. Are you Spanish, Hispanic, or Latino or none of these (select all that apply).

SpanishHispanicLatinoNone of these
20. Choose one or more races that you consider yourself to be

WhiteBlack or African AmericanAmerican Indian or Alaska NativeAsianNative Hawaiian or Pacific IslanderTwo or more races
21. Are you currently employed?

YesNo
Since we are funded to serve first generation, low-income participants the following 3 questions are needed to determine your eligibility for the program.
22. Did either of your parents receive a 4-year college degree (bachelors degree)?*

YesNo
23. What is your total taxable income for the last year? (Please note: Taxable income is the amount of income you actually paid taxes on, it is not your gross income)*

$0 - $20,385$20,385 - $27,465$27,465 - $34,545$34,545 - $41,625$41,625 - $48,705$48,705 - $55,785$55,785 - $62,865$62,865 - $69,945$69,945 and over
24. How many people currently live in your household?*
The following questions are to help us assess your educational needs.
25. What is the highest grade or level of school that you have completed?

Did not complete high school but I am interested in obtaining a TASC/GED.Currently a Junior (Grade 11)Currently a Senior (Grade 12)High School or GED/TASC graduateSome College or Technical School, but did not complete a degree or certificateGraduated 2-year College or Technical SchoolGraduated 4-year CollegeCurrently attending a College or Technical SchoolOther
If you are an adult who didn't complete high school, would you like information about obtaining a TASC/GED?

YesI am currently enrolled in a TASC/GED programNo
26. (Optional) If English is not your native language, do you need assistance with English Language Proficiency?

YesNo
27. What type of post secondary school are you interested in attending?

Vocational/Technical School2 Year College (Associate Degree)4 Year College (Bachelor Degree)
28. What semester (fall, spring, summer) and year are you interested in beginning school? (i.e. Fall 2021)
29. What majors or careers are you interested in pursuing?
30. What kind of educational support do you need to continue or begin post-secondary education? Choose all that apply

Financial aid helpCareer SearchAdmission to college or technical schoolAcademic AdvisingStudy SkillsEducational CounselingTutoringDefaulted student loan reconciliation
31. How did you learn about the Heart of Appalachia Educational Opportunity Center?

EOC Presentation (specify below)Workshop (specify below)Referral (specify below)EmailFacebookPhone contact
EOC Presentation - Where?
Workshop - Which one?
Referral - Who?
Once your application is received, you will be contacted by one of our educational counselors to determine what other steps are needed to being the post secondary education process. It is important that you respond to this contact or you may go ahead and contact them by email or phone numbers listed below:

Patty Moore
Counselor for Cabell, Wayne & Lincoln Counties
Moore21@marshall.edu
(606)547-2482

Roxanne Smith
Counselor for Cabell & Mason Counties
Smith221@marshall.edu
(304)840-5249
32. What is the best way to contact you? Check all that apply.

phoneemailfacebook chat
33. What is the best day to contact you? Check all that apply.

MondayTuesdayWednesdayThursdayFridaySaturday
34. What is the best time of day to contact you? Check all that apply.

Morning (8:00 am until 11:00 am)Mid-day (11:30 am until 4:30 pm)Evening (after 5:00 pm)
I hereby authorize any school, college, or university to release any academic and financial aid information from my files requested by the Heart of Appalachia Education Opportunity Center (HOAEOC). I hereby authorize HOAEOC to release academic and financial aid information to assist in my education. I hereby authorize government agencies to release to HOAEOC the financial documentation necessary to enable my participation in the program.
SIGN HERE*

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