Palm Beach State College-Central-EOC-Application Form

Palm Beach State College

Permission Form to Receive TRiO EOC Services

The TRIO Educational Opportunity Center (EOC) is a federally funded program through the U.S. Department of Education and is sponsored by Palm Beach State College. This document can be completed by any individual who seeks assistance from the Educational Opportunity Center.

EOC participants must be:

(1) A U.S. citizen, national, permanent resident or other eligible noncitizen

(2) A high school senior unable to be served by the Educational Talent Search program, high school dropout, veteran, and/or an adult 19 years or older

(3) Enrolled or interested in enrolling in a college, university, or training program

NEEDS ASSESSMENT
NEEDS ASSESSMENT

Which of the following services are you interested in receiving? Mark all that apply.
Information about and/or assistance with:*

Referral to GED programs or testingApplying for admission to collegeApplying for financial aid to help pay for college costsSelecting a career or majorReferrals to tutoring, counseling or other servicesScholarship SearchStudent Loan Consolidation/Repayment OptionsDefaulted Student LoanResource Referral(food, shelter, clothing, mental health)

EDUCATION
EDUCATION
What is your current educational status?*

High School StudentHigh School DropoutHigh School/GED GraduateGED StudentCollege StudentOther
Do you receive free and reduced lunch?*

YesNoNot Applicable
SDPBC Student Number
High School Attended*
Colleges you are interested in:*
Career, Area or College Major of Interest (Or Undecided)*

FIRST-GENERATION STATUS
FIRST-GENERATION STATUS (please answer BOTH questions)
1. Which parent(s) did you regularly reside with and receive at least 50% of more of your financial support from during your childhood (i.e., until you were 18 years old)?*

Both mother and fatherNeither mother nor fatherMother onlyFather only
2. Did the parent(s) listed above receive a four-year college degree (Bachelor's Degree) in the US?*

Both mother and fatherNeither mother nor fatherMother onlyFather only

PARENT/LEGAL GUARDIAN INFORMATION
PARENT/LEGAL GUARDIAN INFORMATION

If you are a dependent student, your parent is required to provide his/her information and a signature at the end of this form.
Parent/Legal Guardian Name*

First NameLast Name
Cell #*
(999)999-9999
Parent Email*
example@example.com