Kilgore College-EOC-Application Form

Kilgore Campus
1100 Broadway
SS Building, Room 111
Kilgore, TX 75662
(903)983-8615

Longview Campus
209 S Center St,
Longview North Bldg., Room 205F
Longview, TX 75601
(903)236-2026

Name:*

First NameMiddle InitialLast Name
Who referred you to our EOC Program?*
Date of Birth:*

MonthDayYear
mm-dd-yyyy
County:*
County or Residence:*

GreggHarrisonUpshurRuskNone of these
Do you live in the Dorms at Kilgore College:

YesNo
If yes, Which Dorm?
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:*
(999)999-9999
Email:*
example@example.com
Marital Status*

SingleMarriedDivorcedWidowed
Month and year if married, separated, divorced or widowed
Gender:*

MaleFemaleNon-Binary
Which one of your parents completed a 4-yr degree?*

NeitherFatherMotherBoth
Are you currently a participant in another TRIO program?*

YesNo
If yes, which program are you a participant?
Are you a veteran of the U.S. Armed Forces?*

YesNo
Are you currently serving as an Active-Duty Member of the Military?*

YesNo
Are you the Spouse or Child of a member of Active-Duty Military?*

SpouseChildNeither
Are you a U.S. citizen or Permanent Resident?*

YesNo
If no, are you an eligible non-citizen?

YesNo
Alien Registration Number A- (If applicable)
PY 2021-2022*
PY*
Confidential Application for Program Services
Have you ever been enrolled in an institution of higher education prior to this year?*

YesNo
Ethnic Category:*

Hispanic or LatinoNot Hispanic
Race/Ethnicity: (check all that apply)*

American Indian or Alaska NativeAsianBlack or African AmericanWhite / CaucasianNative Hawaiian or Other Pacific IslanderHispanic/Latino
Is English your first language?*

YesNo
Parent/Guardian 1 Name

First NameLast Name
Parent/Guardian 1 Phone Number
(999)999-9999
Parent/Guardian 1 Email
example@example.com
Parent/Guardian 2 Name

First NameLast Name
Parent/Guardian 2 Phone Number
(999)999-9999
Parent/Guardian 2 Email
example@example.com
FINANCIAL STATUS

Statement of Family Income
Please select:*

Independent (over 24 years old OR *provides more than 50% care of a child, OR is *married, OR *homeless, OR **under legal guardianship)Dependent student (Under the age of 24 unless ***exceptions are in existence)
*Living in your car, sleeping on a family or friend's sofa, floor,or extra bed, but not on their lease, staying in a homeless shelter, or having proof that you have lived in a homeless shelter.

** Court documents that can be presented to show legal guardianship by someone other than your parents.

*** Exceptions might be that parents are incarcerated, deceased, abusive (have documentation of past incidences), or you have experienced human trafficking.
Are you a High School Senior today?

YesNo
What is your current family size? Include all who live with your family, do not include roommates. *
What is your current family size? Include all who live with your family, do not include roommates. *
Family’s Total Taxable Income *
Family’s Total Taxable Income *
Find this information on Line 15 of the IRS 1040 Income Tax Return if you or your parents filed (Required)
If did not have to file, Reason for not filing
Year of Taxable Income Reported*

202320242025
Household Funding Sources*

Food StampsUnemployment BenefitsTANFSocial Security BenefitsMedicaidPublic HousingVeteran’s BenefitsNone of these
HIGHEST LEVEL OF EDUCATION
Please select:*

Senior in High School No Dual EnrollmentSenior in High School In Dual EnrollmentHigh School GraduateEnrolled in GED ProgramGED GraduateNeither HS or GED GraduateEnrolled in CollegeAttended CollegeCompleted Associate Degree
What High School?*
Where?*
Year?*
Last Grade Attended and School*
Institution:*
Please Select:*

Senior in High School (now)High School GraduateEnrolled in GED ProgramGED GraduateNeither HS or GED GraduateCurrently Enrolled in collegeAttended College BeforeGraduated from College
Senior in High School (now): Where?*
High School Graduate: Where?*
High School Graduate: Year?*
Enrolled in GED Program: Last Grade Attended and School*
GED Graduate: Year Graduated?*
Currently Enrolled in college: Where?*
Attended College Before: Where?*
Graduated from College: College Name*
SERVICES NEEDED
Please check all that apply*

GED Classes / TestCareer InformationFinancial Literacy InformationAdmissions / Application AssistanceFinancial Aid AssistanceFAFSA Verification AssistanceApplying to Financial Aid for Independent StatusEnrollment / Course SelectionAcademic Coaching / CounselingACT PrepHigh School TranscriptGED TranscriptPostsecondary TranscriptFinancial Aid Suspension AppealAcademic Suspension AppealDefaulted Student LoanOther

Certification and Signature

I certify that all of the above information is true and completed to the best of my knowledge	I certify that the information provided concerning citizenship is accurate	I certify that the information provided concerning taxable income is accurate
I authorize the release of my college records to EOC TRIO Program	I understand that the completion of this application does not guarantee acceptance in the EOC program	I authorize the use of my photograph in TRIO EOC publication and media releases

I understand that in order to receive KC EOC Services, I must provide proof of income. The Kilgore College Educational Opportunity Center is authorized to access or release family income, admissions, academic and/or financial aid information deemed necessary to assist me in achieving my educational goals or in meeting the program reporting requirements of the US Department of Education. A copy of signed statement shall serve as permission for release/sharing of information. * I give the Kilgore College EOC staff permission to obtain my social security number from my high school counselor when needed to verify my FAFSA submission. I also grant EOC at Kilgore College permission to obtain a copy of my final high school diploma from my high school counselor in order to confirm that I graduated from high school.

Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
If you are 17 or younger, please have your legal guardian or parent sign here.
Parent Signature

Clear
Parent Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
To schedule an appointment with an Educational Opportunity Center advisor, please visit https://linktr.ee/trioeoc or email Rhopkins@kilgore.edu with questions

Kilgore College prohibits discrimination, including harassment, against any student on the basis of sex, race, color, religion, age, national origin, disability, veteran’s status,
genetic information, or any other characteristic protected by institutional policy or local, state, or federal law.

Kilgore College TRIO Educational Opportunity Center is 100% federally funded by the U.S. Department of Education. The annual budget is $241,332.00 to serve 850 participants, who are from Gregg, Harrison, Rusk and Upshur Counties that are non-traditional, low-income, first generation college students, and students that have disabling conditions