Eastern New Mexico University-Roswell-EOC-Application Form

Educational Opportunity Center

Program Year: 2024-2025
College Level

Freshman (1st time attending college)Freshman (1-29 credits)Sophomore (30-59 credits)Junior (60-89 credits)Senior (90-bachelor credits)
Are you currently enrolled in college or taking college classes(Fall 2022, Spring/Summer 2023)?

YesNo
Are you in any other TRIO Programs (SSS, TS, UB)?

YesNo
TRIO Program

Educational Opportunity CenterMcNairStudent Support ServicesTalent SearchUpward BoundUpward Bound Math-ScienceVeterans Upward Bound
Trio Program:
Name*

First NameMiddle Initial Last Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Telephone
(999)999-9999
Email Address*
example@example.com
Date of Birth

MonthDayYear
Date
Age
Social Security Number
999-99-9999
Gender

MaleFemale
Are you a U.S. Citizen or Permanent Resident?

YesNo
Ethnicity

Native AmericanAsianBlack or African AmericanHispanicWhiteNative Hawaiian/Other Pacific IslanderMore than one race reportedNot reported
High School Diploma/GED

YesNo
As of today, what is your level of education:

Graduated High school or received GED/HISETHigh School (9th – 11th grade)High School Senior (12th grade)Currently enrolled in alternative education program (GED/HISET)Currently enrolled in collegeCollege dropout not currently enrolledCollege student seeking to transfer
Date Completed

MonthDayYear
MM-DD-YYYY
Did you graduate from HS or receive GED/HISET

YesNo
Other levels of education that may apply:

High School Senior (12th grade)Currently enrolled in alt. ed. program (GED/HISET)Currently enrolled in college.Some college but not currently enrolledCollege student seeking to transfer
Which Semester
Currently enrolled in college (circle semester)

FA 23Sp 24Su 24
Other levels of education(check all that apply):

HS seniorCurrently in GED or HS ProgramHS DropoutSome College/Dual CreditCollege Graduate
Have your Father or Mother Completed a Bachelor's Degree?

YesNo
Parents Education Level: Father, HS Grade/GED

YesNo
Parents Education Level: Mother, HS Grade/GED

YesNo
First in Family to Attend College?

YesNo
Single parent family?

YesNo
Do you have children and/or are you married?

YesNo
Family's Taxable Income (Yearly)
$______
Number in Household
College Choices
(For example, ENMUR, NMSU, UNM)
Career/Degree Choice
(For Example, HVAC, Nursing, Education)
Military Status

VeteranMilitary duty activeSpouse of active duty militaryChild of active duty military

Does anyone in your household receive the rolling (Other Assistance)/Amount received monthly

	Yes/No?	Amount
Social Security
Child Support
Workers Comp.
TANF
Veterans Benefits
Unemployment Comp.
N/A

Total Amount Received Monthly
$_____
Do you consent to receive text messages from EOC on FAFSA reminders and events?

YesNo

Has EOC counselor assisted student in the following

	Yes/No?
Client interested in attending College/University
Provided information and/or assisted in filing for FAFSA
Provided an admission form and/or assisted filing application
Student received check list of necessary items to complete FAFSA
Enrolled in a continuing educational program
Provided information for scholarships
Reviewed Financial Literacy Loan Process

Which of the following services would be helpful to you: (select all that apply)

Financial aid assistanceCollege admissions assistanceFinancial Literacy information/processCollege re-entry processGED/HISET assistanceOther
I certify that the information contained in the application is true, complete and correct to the best of my knowledge. I understand that I am giving permission of consent for the Educational Opportunity Center at ENMUR to view my federal taxes, government benefits, student records, enrollment status for tracking purposes and to complete the free application for the Federal Student Aid (FAFSA).

YesNo
Although disclosure of these items is not required, ENMU-Roswell must report this data in composite form to state and federal agencies. It is the policy of ENMU-Roswell not tot discriminate on the basis of race, creed, sex, color, age, disability, or national origin in its educational programs, activities, or, or employment procedures. Funded by the U.S. Department of Education. Award Number: P066A210130
Student Signature:

Clear
Date

MonthDayYear
mm-dd-yyyy
Parent Signature: (Required if the student is under 18 years old)

Clear
Date

MonthDayYear
mm-dd-yyyy

Educational Opportunity Center