Midlands Technical College-EOC-Participant IVF

The Educational Opportunity Center (EOC) is a federally funded TRiO program and is required by the U.S. Department of Education to obtain income information for participants. It is important that you complete the form below or provide a copy of your tax return (1040) for the current year. If you are currently married (including legal same sex marriages) income information for both you and your spouse is required. All financial information will be kept confidential and will only be used for federal reporting purposes.

Participant Name*

First NameLast Name

Email*

example@example.com

Social Security Number*

WHAT IS YOUR MARITAL STATUS AS OF TODAY?

PARENT EDUCATION INFORMATION Did the participant’s MOTHER or FATHER graduate from college with a four-year degree?

PARTICIPANT INCOME INFORMATION: Did you complete an IRS income tax return?

What is your adjusted gross income?

What is your taxable income (if you filed a tax return)?

As of today, are you currently a dislocated worker?

How many people are in your household?

How many will be in college during the award year?

Dependency Status Questions
If you answer “NO” to all of these questions, have your parents' compete the “Participant Income Verification Form”

Date of Birth

mm-dd-yyyy

As of today, are you married?

At the beginning of the school year, will you be working on a master’s degree or doctorate degree (such as an M.A., MBA, M.D., J.D., Ph.D., Ed.D., graduate certificate, etc.)?

Do you now have or will you have children who will receive more than half of their support from you between during the award year?

Do you have dependents other than your children or spouse who live with you and who receive more than half of their support from you during the award year?

Are you currently serving on active duty in the U.S. armed forces for purposes other than training?

Are you a veteran of the U.S. armed forces?

At any time since you turned age 13, were both your parents deceased, were you in foster care, or were you a dependent or ward of the court?

Has it been decided by a court in your state of legal residence that you are an emancipated minor?

At any time on or after July 1, 2019 or 2020, were you determined to be an unaccompanied youth who was homeless or were self- supporting and at risk of being homeless?

Do you have a special circumstance that may prevent you from completing the financial aid process?

PARTICIPANT HOUSEHOLD BENEFITS List year below if anyone in the household received any of the following benefits.

	Received	Year
Supplemental Security Income (SSI)
Medicaid Benefits
Supplemental Nutrition Assistance Program (SNAP)
Free or Reduced Priced School Lunch
Family Independence (FI)
Special Supplemental Nutrition for Women, Infants, and Children (W IC)

CERTIFICATION AND SIGNATURE

I/We certify that all the information provided including my taxable income and/or annual gross income is correct and true to the best of my knowledgeI/We understand that the information provided on this application will be held in confidence by the EOC staff.I/We authorize the release of my school and/or financial records to the EOC program, including test scores and any other academic information and test results necessary to complete the program application process.

Student Signature

Date

mm-dd-yyyy

EDUCATIONAL OPPORTUNITY CENTER