California State University-San Bernardino-EOC-Application Form
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  • EOC Program Application

    The Educational Opportunity Center is a program funded 100% by a grant from the U.S. Department of Education. EOC provides free academic, career, financial aid and postsecondary information and assistance to eligible participants.

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    • STUDENT INFORMATION 
    • Date of Birth*
       - -
    • Include Social Media Account
    • PARTICIPANT NEEDS ASSESSMENT - Check all you would like information on or need assistance*
    • PERSONAL INFORMATION 
    • Gender*
    • Marital Status*
    • Applicant Citizenship Status:*

    • Permanent Resident: Green Card holder (Permanent Resident) is someone who
      has been granted authorization to live and work in the United States on a
      permanent basis. As proof of that status, U.S. Citizenship and Immigration
      Services (USCIS) grants a person a permanent resident card, commonly called a
      "Green Card."

    • Eligible Non-Citizen: Generally, you are an Eligible Non-Citizen if you are one of the following:

      • U.S. permanent resident, with a Permanent Resident Card (formerly known as an Alien Registration Receipt Card or "Green Card")
      • Conditional permanent resident (I-551C)
      • Other eligible noncitizens with an Arrival-Departure Record (I-94) from the Department of Homeland Security showing any one of the following designations: "Refugee," "Asylum Granted," "Indefinite Parole," "Humanitarian Parole," or "Cuban-Haitian Entrant"
      • A citizen of the Republic of Palau (PW), the Republic of the Marshall Islands (MH), or the Federated States of Micronesia (FM).
      • You can receive federal student aid if you are an eligible noncitizen. You must enter your eight or nine-digit Alien Registration Number (ARN) on the FAFSA.
    • Rows
    • Are you Hispanic/Latino?*
    • Indicate your race (Check all that apply)*
    • Employment*
    • Is English your first language?*
    • Did at least one of your parents receive a 4-year college degree?*
    • Special Circumstances (Check all that apply)
    • HOUSEHOLD INFORMATION 
    • Dependent or Independent?*

    • Note: An Independent Student is one of the following: at least 24 years old, married, a graduate or professional student, a veteran, a member of the armed forces, an orphan, a ward of the court, someone with legal dependents other than a spouse, an emancipated minor or someone who is homeless or at risk of becoming homeless.
      *If none of these apply to you, you are a Dependent Student*

    • Dependent Student

    • If you are a DEPENDENT, provide YOUR PARENTS’ income.

    • Income Includes (Check all that apply)*
    • Last year, what was your parents’ “taxable” income? (Fromyour IRS 1040) **
    • Last year, what was your parents’ “taxable” income? (From your IRS 1040)*

    • Independent

    • If you are an INDEPENDENT, provide YOUR income.

    • Income Includes (Check all that apply)*
    • Do you have children that you need to support?*
    • Last year, what was your “taxable” income? (From your IRS 1040) *
    • Last year, what was your “taxable” income? (From your IRS 1040)*
    • Are you interested in enrolling in any of the following? Mark all that apply
    • HIGH SCHOOL OR SECONDARY EDUCATION INFORMATION 
    • Have you Received a High School Diploma or High School Equivalency degree (GED, HiSet)?*
    • What did you receive?
    • High School Equivalency
    • Are you currently enrolled in a High School Diploma or High School Equivalency(GED, HiSet)?
    • Are you interested?

    • PROGRAM SERVICES

    • What services would you like to receive? (must mark at least one): Primary Services*
    • Supplementary Services (mark all that apply)*
    • Do you or your parents have a migrant or seasonal worker background?
    • COLLEGE OR POST SECONDARY EDUCATION 
    • Are you currently/have you ever enrolled in college/vocational training?*
    • Are you interested?*
    • Received an AA college degree?*
    • Are you interested in pursuing a program of postsecondary education?*
    • What type of program would you like to pursue?*
    • What is the highest level of postsecondary education you have achieved?*
    • Are you currently enrolled in a program of postsecondary education?*
    • Submitted a FAFSA for 2022-2023?*
    • Do you need help to submit your FAFSA?*
    • Would you like assistance or information on applying for financial aid (ex. FAFSA, Cal Grant, scholarships, work study)?*
    • PREFERENCES 
    • What is your preferred method of contact?
    • What is your preferred language of communication?
    • STUDENT'S DECLARATION & SIGNATURE 

    • Authorization: I declare under penalty of perjury that all information reported on this application is true and accurate to the best of my knowledge. Pursuant to 20 USA 1231a of the U.S. Department of Education, EOC has the responsibility to request from applicant information and supporting documents to determine eligibility and deems necessary to assist me in achieving my educational goals or in meeting the reporting requirements of the U. S. Department of Education. To record pertinent facts regarding my eligibility in the program, services rendered, and post-secondary education enrollment. I hereby authorize any educational institution to release academic and/or financial aid information that is requested by EOC. This information is protected by the Privacy Act, kept confidential and not be seen unless specifically authorized. I also grant permission for my image to be used in relation to any EOC activities which could be a photograph and/or video and may be used on the EOC website with only first names to be included or posted.

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