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

  • Today's Date*
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  • NEEDS ASSESSMENT

    Which of the following services are you interested in receiving? Mark all that apply.

  • Information about and/or assistance with:*

  • PERSONAL INFORMATION

  • Birth Date*
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  • Gender*

  • PARTICIPANT PROFILE

  • Are you a US Citizen?*
  • What is your current dependency status?*
  • What is your primary language spoken in your home?*

  • What is your current status in the military?*
  • Are you the dependent or spouse of a veteran, reserved, or active service member?*
  • If Yes, which best describes your current status?
  • As of today, what is your marital status?*
  • What is Your Ethnicity?*
  • Please Select One or More Races*

  • 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)?*
  • 2. Did the parent(s) listed above receive a four-year college degree?*

  • EDUCATION

  • What is your current educational status?*

  • Do you receive free and reduced lunch?*

  • 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.

  • Income Tax Form (please fill in BOTH responses)

    If you are an independent student, please answer the questions below about yourself. If you are a dependent student, a parent must provide information on household size and income.

  • 2. Taxable Income from 2025 Income Tax Form 1040 Line 15 was:

  • AUTHORIZATION FOR RELEASE OF INORMATION

  • To whom it may concern: I, {pleaseType} give my permission to any public school, educational program, and/or postsecondary institution that I have attended or may attend in the future as well as the National Student Clearinghouse to release to the PBSC Educational Opportunity Center, upon their request, all information pertinent to my educational program, including a copy of my financial aid application and awards, transcripts, college enrollment status. I also authorize the use of my name and/or photograph for editorial, promotional, recruitment or educational purposes. By completing and submitting this application, I attest that all of the information on this application is true, complete and accurate.

  • Clear
  • Date Signed*
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  • Clear
  • Date Signed
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  • Should be Empty: