University Of Wisconsin-Milwaukee-EOC-Application Form

Online Application

Welcome to the Educational Opportunity Center! Please complete our program application in order to receive our support. This information is important to understand how to best serve you and is kept confidential. All EOC services are FREE.

Demographic Information

Name*

First NameLast Name

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Date of Birth*

mm-dd-yyyy

Residency Status*

U.S. CitizenPermanent ResidentPermanent Resident of Trust Territory of Pac. Is.In U.S. with intention of permanent residency

Income received last year*

Number of people in your household*

Mother has a 4 year bachelor's degree*

YesNoUnknown

Father has a 4 year bachelor's degree*

YesNoUnknown

Are you Hispanic/Latinx*

YesNo

Race*

Gender*

MaleFemale

Email*

example@example.com

Home/Mobile Phone

(999)999-9999

Are you enrolled in college?

YesNo

If Yes, where?

Milwaukee Area Technical CollegeUniversity of Wisconsin-MilwaukeeOther

Are you enrolled in an HSED/GED/ABE program?

YesNo

If Yes, where?

What EOC services are you interested in receiving?

Do you want to learn more about transferring to a 4-year college/university?

YesNo

Eligibility

Employment Status

Employed/Full TimeEmployed/Part TimeSeeking EmploymentNot in the Job Market

Do you receive any of these benefits?

Are you military connected?

YesNo

If yes, choose from these options:

Active duty militaryChild of active duty militarySpouse of active duty militaryVeteran

Other

Disabled (Learning)Disabled (Physical)Currently Incarcerated

English is my first language

YesNo

I need ESL classes

YesNo

Martial Status

MarriedSingleOther

Educational & Career Goals

I am interested in going to college

YesNo

Educational Goal

1-Year Certificate2-year Associate degree4-year Bachelor's degree

Are you a parent of children under the age of 18?

YesNo

Consent/Contract

I certify that the information provided here is accurate. I understand that it can be used for statistical and tracking purpose only. I authorize UWM EOC to obtain records relevant to my educational planning and financial aid eligibility, and to release information as required by law to the US Department of Education. EOC has my permission to contact me to collect enrollment information and to provide further services. I agree to abide by the rules of the UWM Educational Opportunity Center

Signature