Gadsden State Community College-EOC-Application Form

  • CHEAHA EDUCATIONAL OPPORTUNITY CENTER (EOC)
    APPLICATION
    GADSDEN STATE COMMUNITY COLLEGE

  • Date of Birth:*
     - -
  • Gender:*
  • Can we text you?*
  • Ethnicity:*
  • Are you a U.S. Citizen?*
  • Are you a Veteran?*
  • Are you a Dependent?*
  • Are you age 19 or older?*
  • Are you a High School Senior?*
  • GED or High School Diploma?*
  • Are you currently enrolled?*
  • Annual Taxable Income*
  • Do either of your parents have a 4-year college degree?*
  • Status:*
  • Can we communicate with you via text?*
  • Are you a part of any of the following federal programs?
  • Are you a resident of Calhoun, Cleburne, Cherokee or Etowah County?*
  • Are you 19 years of age or older?*
  • Are you a high school senior?*
  • Are you currently enrolled in high school or college?*
  • Do you have a GED or high school diploma?*
  • Are you a first-generation college student? (You are considered a first-generation college student if neither of your parents have a four-year college degree)*
  • Are you a dependent?*
  • How can EOC help you?*
  • Please check ALL the services you need:*
  • Check All That Apply:*
  • Race:*
  • Are you of Hispanic ethnicity?*
  • Is English your native language?*
  • If you are not a U.S. Citizen, are you a permanent resident?*
  • Are you currently a participant in a Talent Search or EOC program?*
  • Did either of your parents/legal guardians graduate from a 4-year university?*

  • Disability Eligibility:

  • Do you have a disability?*

  • Academic Goals:

  • Academic Goals:*

  • I verify that the information on this form is true and complete to the best of my knowledge and grant the Cheaha Educational Opportunity Center (EOC) staff permission to review information maintained as part of my permanent records, including admissions data, enrollment data, or other information pertinent to my status in the EOC Program. I authorize EOC to obtain information from financial aid including financial awards. I give Gadsden State permission to send my information to the National Student Clearinghouse for future tracking of college enrollment and/or graduation. I understand my photo may be taken at EOC events and used on marketing and social media. Choosing to opt out of photo opportunities during these events will be my own responsibility. Failure to remain an active EOC participant will result in removal from the program

  • Clear
  • Date*
     - -

  • Independent Student:

  • Check which was your taxable income in 2021:*

  • Dependent Student:

  • Check which was your taxable income in 2021:*
  • Workshops:*

  • It is the policy of the Alabama Community College System, including all institutions under its control, that no person shall, on the grounds of race, color, disability, gender, religion, creed, national origin, or age, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program, activity, or employment. (Each institution will make reasonable accommodations for qualified disabled applicants or employees.)

  • Cheaha Educational Opportunity Center is fully funded by a grant of $232,050 by the U.S. Department of Education

  • Dependent Students and Independent Students
    If you can answer “yes” to any of the questions below, please check the box.

     

  • A student can be considered an Independent Student (even if a student is under the age of 24) for the following reasons:*

  • * If you are not sure if you were in foster care, check with your state child welfare
    agency. You can find out the contact information for your state child welfare
    agency by visiting your state child welfare agency.

  • I file as*

  • GADSDEN STATE COMMUNITY COLLEGE
    CHEAHA EDUCATIONAL OPPORTUNITY CENTER (EOC)
    INCOME VERIFICATION FORM

    I, {main_name}, as an applicant for the Educational Opportunity Center (EOC) Program at Gadsden State Community College (GSCC) do hereby verify, to the best of my knowledge, that my household taxable income for 2021 was ${myHousehold}.

    Number in Family {numberIn85}.  {iFile}

  • Clear
  • Clear
  • Date*
     - -

  • EDUCATIONAL OPPORTUNITY CENTER (EOC)

    Confidentiality Statement


    The EOC Program Staff and tutors are here to help you be successful at earning your GED or diploma, or enrolling in college. While we pride ourselves on being an active and cooperative learning community, we also understand the importance of protecting the confidentiality of the academic and personal information you share with us.


    This statement is to notify all EOC participants that academic and personal confidentiality can be breeched when GSCC policy mandates that security, administrators or staff be notified. In order to maintain a productive and safe environment for everyone, please read and sign the Student Code of Discipline standards related to mandatory staff reporting.


    Student Code of Conduct (Actions requiring mandatory reporting):
    1. Destruction, damage, theft or misuse of College public or private property
    2. Being in possession of or under the influence of alcoholic beverages or non-prescribed, controlled drugs on College property or at a student or College-sponsored function
    3. Disruptive or disorderly conduct that interferes with or threatens the health and/or safety of the College community or adversely affects the educational environment of the College including physical or verbal abuse, threat of violence, intimidation, and physical or mental harassment

  • If you tell an EOC staff member or a tutor that you are in immediate danger of hurting yourself or someone else, we are obligated to inform GSCC Administrators.

  • Date:*
     - -
  • Clear
    • Submit 
    • Should be Empty: