The College Board-Washington-EOC-Application Form

The Educational Opportunity Center

Washington, D.C.

CONFIDENTIAL REGISTRATION FORM

The following information will be used to determine eligibility for services from EOC for 2024-25 project year.

Family and Income
Please indicate your household's TAXABLE INCOME range from last year* (2023 tax form 1040; Line 15). If unsure, please write "0" or "n/a" and speak to your counselor.*
"Please indicate your household's TAXABLE INCOME range from last year* (2023 tax form 1040; Line 15) Line 15"*

Less than $21,870$21,870-$29,580$29,580-$37,290$37,290 -$45,000$45,000-$52,710$52,710 -$60,420$60,420-$68,130$68,130-$75,840More than $75,840
Income Source
Family Size*
Number of People in Household Including You
Total Number of people in your household (include yourself):*

123456789+

Does either parent have a four-year (Bachelor's) degree?*

	Yes	No
Parent 1
Parent 2

Check Current Educational Status*

Current HS Junior (11th grade)Current HS Senior (12th grade)HS/GED GradHS DropoutIn GED/HS Prog.Current College Student (Postsecondary student)Some College (Postesecondary Stopout)
I have a desire to enroll in:

GED programVocational/Technical School2-year CollegeTransfer from 2-yr to 4-yr program4-year College or UniversityOther
Career Goal/Major
Assistance Needed

AdmissionsFinancial AidGEDFinancial EducationOther

To better assist you with financial education, please answer the following questions:

	Yes	No
Do you have previous education loan debt?
Are you currently in default on an educational loan?
Have you created a budget to help pay college expenses?
Do you know how to get your credit score or rating?

Name of EOC Counselor Who Assisted You (Use Drop Down Box to select)*
Outreach Site Where You Were Served*
Name of EOC Counselor Who Assisted You (Use Drop Down Box to select) *
Documents

Federal 1040 Tax FormsSocial Security StatementPublic Assistance (TANF) StatementFood Stamps (SNAP) BenefitsPCRF FormSession PicturesFAFSA SAROther
Documents (you can provide to help your counselor with your case):

Federal 1040 Tax FormsSocial Security StatementPublic Assistance (TANF) StatementFood Stamps (SNAP) BenefitsPCRF FormSession PicturesFAFSA SAR

Signature
The College Board Educational Opportunity Center is a USDE grant funded project which does not discriminate on the basis of age, color, national origin, sex, handicap, or religion, in admission policies, the administration and implementation of educational policies, employment, or any other activity. I hereby authorize the exchange of information between the Educational Opportunity Centers (EOC) and other agencies, as necessary to assist me in achieving my educational goals. By signing and dating this application, I certify that the information provided is correct to the best of my knowledge.
Signature*

Clear
Date

MonthDayYear
mm-dd-yyyy
I grant permission for my name/photo to be released for advertising purposes.*

YesNo