Fayetteville State University-EOC-Update Form

Update Form
Educational Opportunity Centers
1200 Murchison Road
Fayetteville, NC 28301
910-672-1171 - eoc@uncfsu.edu
Applicant Name*

First NameMiddle NameLast Name
County
Academic Advisor

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Cell Phone
(999)999-9999
Home Phone
(999)999-9999
Date of Birth

MonthDayYear
mm-dd-yyyy
Email Address*
example@example.com
Gender

MaleFemaleNon-Binary
Instagram Handle
Facebook Handle
Veteran?

YesNo
Active Duty?

YesNo
Spouse of Active Duty?

YesNo
Child of Active Duty?

YesNo
Primary language spoken in home

EnglishSpanishOther
Disability Status:

YesNo
Citizen Status

US CitizenPermanent ResidentOther
PR#
Ethnicity:

American IndianAsian/Pacific IslanderBlack/African AmericanHispanicMulti-RacialWhiteOther
Current Education Level

Adult w/o HS Diploma (19+)HS Graduate/GEDPostsecondary Student2 Year Degree4 Year DegreePostsecondary DropoutPotential Postsecondary Transfer
Name of School if HS Senior, 2 Year Degree, or 4 Year Degree
GED/AHS program currently attending
Interested in attending
College you previously attended
Name of college attending
College interested in attending
Intended enrollment date

MonthDayYear
mm-dd-yyyy
Intended Major

Needs Assessment

	Yes	No
I need academic/educational advising/coaching
I need college admissions information/application assistance
I need college admissions fee waivers
I need scholarship information/application assistance
I need assistance completing FAFSA
I need career counseling/workshops/mentoring
I need college re-entry assistance/transfer information/assistance
I need help with financial literacy (i.e., banking, budgeting, saving, etc.)
I need to better understand my interests, abilities, and other traits
I need a GED referral
I need a community service agency referral
I need to visit college campuses to explore my options
I need to get involved in positive activities, extra-curricular activities and/or clubs
I have thought about dropping out of school
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 need assistance resolving defaulted student loans

Needs Assessment

	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.