• EDUCATIONAL OPPORTUNITY CENTERS APPLICATION FORM

    The following information will be used to determine eligibility for services from EOC for 2021-22 project year

  • Okay to text?*
  • 7. Date of Birth*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 9. Gender*
  • 10. Ethnicity: Are you Hispanic/Latino?*
  • If "No", please select from below*
  • 11. Is English your first language?*
  • 12. U.S. Citizen?*
  • 13. Please check if you are a (an)*
  • 14. As of today, are you*
  • 15. Are you now or have you been*
  • 16. Did you file taxes last year?*
  • 17. If under the age of 24, did your parent(s) file taxes last year?*
  • 18. Please indicate your household’s TAXABLE INCOME range from last year*(2020 tax form 1040: Line 15)*
  • 19. Total # in household including self*
  • 16. Number of Dependents: Are you providing more than 1/2 of the support for any children or other dependents (not including a spouse)?*
  • 21. Family's taxable income*
  • 20. Are you or anyone in your household receiving*
  • 21. Did either parent receive a 4-year degree before you turned 18?*
  • 22. What is your CURRENT educational status? Select ONE*

  • Education Information

  • 21. Did either of your parents, or the parent you lived with prior to your 18th birthday, receive a 4-year college degree?*
  • 22. What is the highest grade you completed?*
  • Have you completed a 4-year college degree?
  • 23. Are you currently enrolled in College/Tech school*
  • 24. Are you currently enrolled in a GED Program?*
  • 25. Have you ever attended a community or technical college or a university in the past?*
  • 26. Did you earn a certificate or associate degree?*
  • 27. I have a desire to enroll in*
  • 27. When do I desire to enroll (Enter year on line provided)*
    Rows
  • 28. When do I desire to enroll
  • 29. I Need Information On (Check all that apply)*
  • 30. I Need Assistance With (Check all that apply)*
  • 31. I grant permission for my name/photo to be released for advertising purposes.*

  • WKU’s EOC program is a USDE grant funded project ($273,793.00) 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 complete and correct in every respect.

    *I certify that, to the best of my knowledge, all information given is correct*

     

     

     

    Both a parent signature and an applicant signature are required if the applicant is under 18 years of age. A parent signature is not required but is preferred if the applicant is 24 years of age or younger and was listed as a dependent in 2020 tax filings.

  • 34. Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
    • Submit 
    • Should be Empty: