California State University Fresno-EOC-Application Form

  • Central California Educational Opportunity Center

    Participant Application

    Funded by the U.S. Department of Education

    • STUDENT INFORMATION 

    • SS# is required to process the application

    • PLEASE ENSURE YOUR SOCIAL SECURITY NUMBER MATCHES IN BOTH FIELDS

    • Date of Birth*
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    • When is the best time to contact you?
    • HOUSEHOLD INFORMATION 

    • If under 24 years of age, provide your parents’ income

    • Income Includes (Check all that apply)*

    • Do you have children that you need to support*
    • Last year, what was your “taxable” income?  (From your IRS 1040)*
    • PERSONAL INFORMATION 
    • Gender*
    • Marital Status*
    • Applicant Citizenship Status:*
    • Are you Hispanic/Latino?*
    • Indicate your race (Check all that apply)*
    • Employment Status
    • Was English your first language?*
    • If no, are you comfortable speaking, reading, and writing in English?
    • Parent(s) received a 4-yr college degree*
    • If YES, I lived with that parent(s)
    • Special Circumstances (Check all that apply)
    • HIGH SCHOOL OR SECONDARY EDUCATION INFORMATION 
    • Do you have a desire to pursue an education beyond high school?*
    • Received a HS Diploma*
    • Obtained a GED/HiSet*
    • Currently in a HS Diploma program*
    • Currently in a GED/HiSet program*
    • COLLEGE OR POST SECONDARY EDUCATION 
    • Received an AA college degree*
    • Did you stop attending college?*
    • Did you stop attending voc. training?*
    • Currently enrolled in college/training?*
    • Submitted a FAFSA this year?
    • Need help to submit FAFSA next year?
    • PARTICIPANT NEEDS ASSESSMENT - Check all you would like information on or need assistance

    • PARENTS’ INFORMATION 

    • If under 24 years, please complete the following

    • STUDENT'S DECLARATION & SIGNATURE 

    • STUDENT'S DECLARATION & SIGNATURE

      Authorization: I declare under penalty of perjury that all information reported on this application is true and accurate to the best of my knowledge. Pursuant to 20 USA 1231a of the U.S. Department of Education, CCEOC has the responsibility to request from applicant information and supporting documents to determine eligibility and deems necessary to assist me in achieving my educational goals or in meeting the reported requirements of the U. S. Department of Education. To record pertinent facts regarding my eligibility in the program, services rendered, and post-secondary education enrollment. I hereby authorize any educational institution to release academic and/or financial aid information that is requested by CCEOC. This information is protected by the Privacy Act, kept confidential and not be seen unless specifically authorized. I also grant permission for my image to be used in relation to any CCEOC activities which could be a photograph and/or video, and may be used on the CCEOC website with only first names to be included or posted.

    • Clear

    • Use your mouse to sign when completing this on a computer; use your finger when using a laptop or other device.

    • Date Signed*
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