Baton Rouge Community College-EOC-Application Form

Baton Rouge Community College Educational Opportunity Center

Federally Funded TRIO Program
- The Baton Rouge Community College TRIO Educational Opportunity Center provides free college and career readiness services to eligible participants. Services include support with college and training exploration, admissions, financial aid and FAFSA completion, academic preparation, and career planning for individuals entering or returning to postsecondary education or workforce training.
  
  Participant Notice: Some demographic questions included in this application are part of required program data collection and reporting. BRCC TRIO EOC is committed to administering these questions respectfully and consistently for all participants. If you have questions or concerns about any item, please contact TRIO EOC staff for assistance
- Name:
  
  First NameLast Name
- Social Security Number:
  999-99-9999
- DOB:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- Biological Sex:
  
  Other
- Our office understands that the language used in this survey may not accurately reflect members of the LGBTQ+ community. Unfortunately, these questions are required by the U.S. Department of Education. We also understand these questions may be triggering for some individuals. Our program supports and advocates for mental health and supports all of our participants.
- What are your pronouns?
  
  Other
- Marital status:
- Address:
  
  Address:
  
  Street Address Line 2
  
  City:State:
  
  Zip:
- Phone number:
  (999)999-9999
- Email:
  example@example.com
- U.S. Citizen
- If 'no' have you applied for permanent status?
- Alien Number
- Ethnic Background:
- Do you consider yourself to be Hispanic or Latinx?
- - (Select all that apply)
  
  Other
- Please check a box if you meet any of these criteria.
- Disability:
- Veteran:
- Employment Status:
- Income Source:
- Taxable Income:
- Form 1040 (line 43)
  
  Form 1040A (line 27)
  
  Form 1040EZ (line 6)
- Do you or anyone in your home receive one of these resources?
- Size of family (including self):
- Highest level of education completed: (Check one)
- Grade Last Completed
- School Name
- Institution Name
- Certificate(s)
- School Name
- If 'Some High School', Grade:
- If 'High School Senior', School Name:
- If 'High School Senior', Graduation Date:
- If 'GED', Currently enrolled at:
- If 'GED', Completed?
- If 'GED', Graduation date:
- If 'Some College', College Name:
- If 'Some College', Degree Pursued:
- If 'Certificate(s)', Please list:
- If 'Associate's Degree', College Name:
- If 'Associate's Degree', Degree:
- If 'Associate's Degree', Graduation Date:
- Did either of your parents’ GRADUATE college with a 4-year (bachelor’s) degree? (check one)
- Mother:
- Father:
- How did you hear about us?
- Name of referring agency, Adult Ed Program, office or workshop location:
- Services Needed
- I declare that the information on this form is true to the best of my knowledge. The TRIO Baton Rouge Community College Educational Opportunity Center Program is authorized to access information deemed necessary to assist me in achieving my educational goals or in meeting the reporting requirements of the as a federally funded program, to record pertinent facts regarding my eligibility in the Program, services rendered, and placement. A copy of this statement shall serve as such authorization.
- I, the undersigned, authorize the TRIO Baton Rouge Community College Educational Opportunity Center Program to use photographs and/or videotape with my image in Educational Opportunity Center publications, promotional media, social media, websites, and/or news releases.
  
  I have read and understand the information provided and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am under no legal obligations.
  
  By signing, I consent to Baton Rouge Community College TRIO Educational Opportunity Center submitting an admission and financial aid application to postsecondary education programs on my behalf.
- Signature of Applicant:
- Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- Parent Signature (if under 18):
- Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- Special Assistance
- If 'Disability academic support information', please select type
- 1. I find it difficult to get started working on projects.
- 2. Instead of learning something new, I would rather practice something I am good at.
- 3. Setbacks do not discourage me.
- 4. I believe that learning should be easy.
- 5. I am often discouraged when things are hard
- 6. It is important to me that I do not make mistakes.
- 7. I often set smaller goals to achieve easier success.
- 8. I believe in finishing whatever I begin.
- I, the under signed, authorize the TRIO Baton Rouge Community College Educational Opportunity Center Program to use photographs and/or videotape with my image in Educational Opportunity Center publications, promotional media, social media, websites and/or news releases.
- Signature of Applicant:
- Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- Parent Signature (if under 18):
- Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- I {main_name} have read and I understand the provided information and have had the opportunity to ask questions. I understand that my participation is voluntary and that I am under no legal obligations.
  
  By signing, I give my consent to Baton Rouge Community College TRIO Delta Educational Opportunity Center to submit an admission and a financial aid application to post-secondary education programs on my behalf.
- Signature of Applicant:
- Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy
- Parent Signature (if under 18):
- Date:
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearmm-dd-yyyy

Baton Rouge Community College Educational Opportunity Center