Fayetteville State University-EOC-Adult Application Form

Fayetteville State University

Educational Opportunity Centers
1200 Murchison Road

Fayetteville, North Carolina 28301

(910) 672-1171 * Fax (910) 672-1207 * eoc@uncfsu.edu

Needs Assessment

	Yes	No
1. I need academic/educational advising/coaching
2. I need college admissions information/application assistance
3. I need college admissions fee waivers.
4. I need scholarship information/application assistance
5. I need assistance completing FAFSA.
6. I need career counseling/workshops/mentoring.
7. I need college re-entry assistance/transfer information/assistance.
8. I need help with financial literacy (i.e. – banking, budgeting, saving, etc.)
9. I need to better understand my interests, abilities and other traits
10. I need a GED referral.
11. I need a community service agency referral
12. I need to visit college campuses to explore my options
13. I need to get involved in positive activities, extra-curricular activities and/or clubs or organizations.
14. I have thought about dropping out of school.
15. I am currently sharing housing due to economic hardship or loss of housing, awaiting Foster Care placement, living in a Foster home, residing in a Group home or an emergency/transitional shelter.
16. I need assistance resolving defaulted student loans.

Needs Assessment -Please check your current needs

	Yes	No
1. I need Educational Advising/Coaching
2. I need Career Information/Advising
3. I need Financial Literacy Activity/Information
4. I need Computer Literacy Skills/Information
5. I need Study & Test Taking Skills Activity
6. I need Financial Aid Advising/Information
7. I need FAFSA (Federal Financial Aid) Assistance
8. I need Scholarship Information/Assistance
9. I need College Admissions Application
10. I need College Application Fee Waiver
11. I need Tours/Information of regional College/University
12. I need Assistance with Default Loans
13. I need Re-entry/Transfer Information/Assistance
14. I need GED (General Equivalency Diploma) Information/Referral/Assessment
15. I am currently sharing housing due to economic hardship or loss of housing, awaiting foster care placement, living in a foster home, residing in a group home or emergency/transitional shelter.

I am currently a participant in the following:*

Upward BoundStudent Support ServicesMcNairUpward Bound/ Math & Science21st Century Community Learning CenterVeterans Upward BoundOther
I am currently a participant in the following program(s):*

Upward BoundUpward Bound Math & ScienceUpward Bound Veteran21st Century Community Learning CentersStudent Support ServicesTalent Search ITalent Search IINone
Participant's Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

First Generation Status
First Generation Status

First Generation Student
Has student’s mother received a 4-year degree from a college/university?*

YesNo
Has student’s father received a 4-year degree from a college/university?*

YesNo

Release Forms
I attest that the taxable income provided above is accurate to the best of my knowledge.
Parent Signature:

Clear
Date

MonthDayYear
mm-dd-yyyy
School Records

I grant Educational Opportunity Centers (EOC) Program permission to obtain academic records, college admissions enrollment, and financial aid information that is necessary to assist in achieving my education goals.

Media Release

Periodically, students participating in the EOC program events may be photographed, filmed, or interviewed.
I grant permission for EOC staff to use my photographs, film or interviews that may be used to promote or publicize the program events or demonstrate how federal funds are utilized to assist students.
I understand that the above information will be kept confidential and used solely in support of my educational and career goals.
All the information provided is true and complete to the best of my knowledge.
Participant Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy