Central Washington University-EOC-Intake Form
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  • Central Washington University
    SCW TRIO-EOC
    Intake Form

    • Step 1: Applicant Profile 
    • Sex*
    • Phone Type
    • Phone Type
    • Date of Birth*
       - -
    • Preferred Contact Method
    • Race/Ethnicity: Are you Hispanic or Latino?*
    • If NO, please select the appropriate response
    • Step 2: Eligibility 
    • Please, select the option that indicates your citizenship status*

    • Rows
    • Did your Father earn a 4-year college degree?*
    • Did your mother earn a 4-year college degree?*
    • Step 3: Verification of Income 
    • Total taxable family income on most recent Federal Income Tax Return; 2025 IRS 1040 Tax Return Line 15 (Please select one)*

    • Source(s) of Income (check all that apply)*

    • Step 4: Educational Information 
    • Do you have a High School Diploma?*
    • Are you currently enrolled in high school?*
    • Do you have a GED or other High School Diploma Equivalency?*
    • Are you currently enrolled in a GED; or other High School Equivalency program?*
    • Are you currently enrolled in high school; GED; or other High School Equivalency program?*
    • Are you currently enrolled in college or vocational training*
    • Have you ever been enrolled in college or vocational training?*
    • Have you completed a college degree or certificate?*
    • Step 5: Other Information 
    • Are you a member of the military or are you the dependent of a member of the military?*
    • Marital Status*
    • Do you have children/dependents who receive more than half of their support from you?*
    • At any time were you an orphan, in foster care or a ward of the state?*
    • Are you homeless or at risk of becoming homeless?*
    • Are you less than 18 years of age and have no parent or guardian?*
    • Do you have a disability?*
    • Are you presently participating in any of the following programs?*
    • How did you hear about CWU TRIO EOC?*

    • Step 6: Needs Assessment 
    • The level of education I would like to achieve is*
    • I am interested in attending the following colleges/universities*

    • I would like assistance with the following (check all that apply)*

    • Step 7: Release of Information and Signature(s) 

    • Information provided to the CWU TRIO-EOC Program is confidential and will not be released without the student's permission.

      By signing below, I authorize the CWU TRIO-EOC Program to receive and release information to and from all applicable educational and career institutions to assist me in my educational planning; enrollment verification; and securing financial aid opportunities. Additionally, my information may be released to the U.S. Department of Education to demonstrate program effectiveness, when requesting renewed funding.

      I verify that the information provided in this intake application is true and accurate.

    • Clear
    • I am 18 years of age or older.*
    • Date Signed*
       - -
    • Clear
    • Date Signed*
       - -
    • Date
       - -
    • I verify that the information provided in this intake application is true and accurate.
    • Low-income eligible
    • Clear
    • Clear
    • Submit 
    • Should be Empty: