• EOC Participant Information Form

    3100 Main Street, Suite 100 Kansas City, Missouri 64111 (816) 604-4400

    The following information is kept secure and confidential.

    • Student Information 
    • Today's Date*
       - -
    • Birth Date*
       - -
    • Citizenship*
    • Is English your first language?*
    • Did either of your biological parents graduate from a 4-year college with a bachelor’s degree?*
    • Do you plan to enroll or re-enroll in college or another training program beyond high school?
    • Demographic Data 
    • Gender*
    • Rows
    • Disability
    • Marital Status
    • Employment Status
    • Provide over 50% support for children/dependents?*
    • Check any that apply
    • Taxable household income level*
    • Ethnicity: Are you of Hispanic, Latino, or Spanish origin?
    • Check all that apply

    • Receiving Services from other Federally Funded Program?

    • EOC Services Requested
    • Educational Data 
    • High School Graduate?*
    • Enrolled in High School?*
    • Received a High School Equivalency diploma?*
    • Enrolled in High School Equivalency program?*
    • What level did you enroll in High School Equivalency program?*
    • Rows
    • Do you wish to have us contact you to schedule a follow-up appointment?

    • We are here to serve you when you are interested in furthering your education.

      https://mcckc.edu/eoc

      http://www.studentaid.gov/

    • Have you received EOC services previously?

    • I hereby certify that the above information is accurate and complete to the best of my knowledge. The EOC is 100% funded by the United States Department of Education.

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