Grays Harbor College-EOC-Eligibility Form

Grays Harbor College

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ຖ້າທ່ານຕ້ອງການເບິ່ງແບບຟອມໃນພາສາລາວ, ໃຫ້ປ່ຽນພາສາຢູ່ມຸມຂວາເທິງ.

TRIO EOC Intake Form

The information you provide in this survey is protected under The Family Educational Rights and Privacy Act.
- https://www2.ed.gov/policy/gen/guid/fpco/ferpa/index.html
Disclaimer: Grays Harbor College administrators three U.S. Department of Education TRIO Programs: TRIO Classic is 100% federally funded at $1,375,525, TRIO STEM is 100% federally funded at $1,309,440 and TRIO EOC is 100% federally funded at $1,160,250 for five-year grant cycle 2021-2026.
- Answers in this section will help us learn more about you and determine likely funding eligibility. Our college is open access. Answers provided here will not screen you out of or prevent you from becoming a student.
  
  This information is confidential.
- 1. & 2. First and Last Name*
  
  First NameLast Name
- 3. Birth Date*
  
  MonthDayYear
  Date
- 4. Email*
  example@example.com
- 5. Phone Number*
  (999)999-9999
- 6. Preferred Contact Method*
  
  TextCallEmail
- 7. Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- 8. Ethnic/Racial Background: Are you Hispanic or Latino/Latinx?*
  
  YesNo
- 9. If NO, please select the appropriate response
  
  American Indian/Alaska NativeNative Hawaiian or other Pacific IslanderBlack or African AmericanCaucasian/WhiteAsianTwo or more races
- Answers in this section will help us learn more about you and determine likely funding eligibility. Our college is open access. Answers provided here will not screen you out of or prevent you from becoming a student.
  
  This information is confidential.
- 10. Please, select the option that indicates your citizenship status*
  
  U.S. CitizenPermanent ResidentN/A
- 11. Did your Father earn a 4-year college degree?*
  
  YesNo
- 12. Did your Mother earn a 4-year college degree?*
  
  YesNo
- Answers in this section will help us learn more about you and determine likely funding eligibility. Our college is open access. Answers provided here will not screen you out of or prevent you from becoming a student.
  
  This information is confidential.
- 13. What is your gross income from the last calendar year?*
  
  No taxable income$20,385 or less$20,386-27,465$27,466-34,545$34,546-41,625$41,626-48,705$48,706-55,785$55,786-62,865$62,866-69,945$69,946 or moreOther
- 14. Total number of people supported by this income, including yourself*
- 15. Source(s) of income (check all that apply)*
  
  Salary/wagesDisabilityVeterans' benefitsUnemploymentSSIFood stampsChild supportOther
- Answers in this section will help us learn more about you, support resources available to you, and determine likely funding eligibility. Our college is open access. Answers provided here will not screen you out of or prevent you from becoming a student.
  
  This information is confidential.
- 16. Are you a first-generation college student?*
  
  YesNo
- A first-generation college student is someone who is the first in their family to go to college. However, there are variations in the way first-gen is defined.
- 17. Do you have a high school diploma?*
  
  YesNo
- 18. Are you currently enrolled in college or vocational training?*
  
  YesNo
- 19. Have you completed a college degree or certificate?*
  
  YesNo
- 20.What is your preferred language?*
  
  EnglishSpanishOther
- 21. Military Status*
  
  VeteranSpouse of Active Duty Military MemberChild of Active Duty Military MemberNone
- 22. Marital Status*
  
  SingleMarriedDivorcedSeparatedWidowed
- 23. Do you have children/dependents who receive more than half of their support from you?*
  
  YesNo
- 24. At any time were you an orphan, in foster care or a ward of the state?*
  
  YesNo
- 25. Are you homeless or at risk of becoming homeless?*
  
  YesNo
- 26. Are you less than 18 years of age and have no parent or guardian?*
  
  YesNo
- 27. Do you have a disability?*
  
  YesNo
- 28. Are you presently participating in any of the following programs?
  
  Upward Bound Math & ScienceUpward BoundTalent SearchGear UpTRIO SSSVeterans Upward BoundNoneOther
- 29. How did you learn about TRIO EOC?
  
  Friend or Family MemberGHC Employee or OfficeGHC WebsiteEmail from GHCInformation Session/Event
- Answers in this section will help us learn more about you and find resources to help you. Our college is open access. Answers provided here will not screen you out of or prevent you from becoming a student.
  
  This information is confidential.
- 30.The level of education I would like to achieve is
  
  GEDHigh School DiplomaAssociate's DegreeBachelor's DegreeGraduate DegreeCertificate
- 31.I am interested in attending the following colleges/universities
  
  Central Washington University (CWU)Eastern Washington University (EWU)Grays Harbor CollegeHeritage University (HU)JM Perry TechUniversity of Washington (UW)Western Washington University (WWU)Washington State University (WSU)Yakima Valley CollegeOther
- 31.I am interested in attending the following colleges/universities
- 32.I would like assistance with the following (check all that apply)
  
  FASFA/WASFA application assistanceTransfer information/assistanceEnroll at GHC or college of choiceScholarship assistanceOther
- 32.I would like assistance with the following
- 33.This certifies that the information on this form is correct to the best of your knowledge. By signing with your electronic signature, you are authorizing TRIO EOC to release and receive information as needed to and from schools/agencies to support your educational goals.
  
  Clear
- 34. Date Electronically Signed
  
  MonthDayYear
  mm-dd-yyyy
- Please upload your Social Security Card
  
  Cancelof
- Please upload your ID
  
  Cancelof

TRIO EOC Intake Form