San Juan College-EOC-Application Form

SAN JUAN COLLEGE

TRiO

Educational Opportunity Center
Participant Application
Date*

MonthDayYear
mm-dd-yyyy
How did you learn about our program?

Friend/RelativeFacebookInstagramWebsiteCollege Fair/Career Fair/Community FairCommunity Organization/StoreEmployerCo-WorkerACE CenterHigh School CounselorSan Juan College Department (Advising Office, Financial Aid, Veterans Office, Student Engagement, etc)TRIO Student Support ServicesDay Care FacilityCounselor/Counseling ServiceGroup PresentationClassroom PresentationCommunity PresentationStudent RushOther
How did you learn about our program?
Other
Social Security #*
999-99-9999
Name:*

First NameLast Name
Birthdate:*

MonthDayYear
mm-dd-yyyy
Age:*
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:*
(999)999-9999
Email:*
example@example.com
Gender*

MaleFemale
MARITAL STATUS:*

SingleMarriedDivorcedWidowed
EMPLOYMENT STATUS:*

Full-timePart-timeUnemployed
ETHNIC GROUP:*

American Indian/AlaskanAsianHawaiian/Pacific IslanderHispanic/LatinoBlack/African AmericanWhite
If applicable, select Tribe affiliation
RESIDENCY STATUS:*

U.S. CitizenOther
Are you a U.S. Permanent Resident with one of the following: Alien Registration Cards: I-151, I-551, or I-551C?*

YesNo
VETERAN:*

YesNo
If applicable, select Military affiliation
Check if you are currently a participant in any of the federal programs listed below:*

Upward Bound (UB) /Math and Science (UBMS)Educational Talent Search (ETS)Student Support Services (SSS)Veterans Upward Bound (VUB)None of the Above
Current Education Level*
PARENTS’ EDUCATIONAL STATUS:
Does your mother have a Bachelor’s Degree?*

YesNoUnknown
Does your father have a Bachelor’s Degree?*

YesNoUnknown
Are you the First in Family to Attend College?*

YesNo
PARTICIPANT NEEDS ASSESSMENT – Check all you would like information on or need assistance*

College informationAdmission applicationFAFSA completionFinancial aid assistanceScholarship assistanceCareer PlanningAcademic GuidanceBudget PlanningChoosing a SchoolFinancial LiteracyDipolma/HiSET/GED ProgramJob Search SkillsDefaulted School LoanVeterans ServicesOther
Size of your family household*
Family size is the number of people for whom the parent (if dependent) or the student (if independent) provides more than 50% of their support- Include Yourself
Family Taxable Income*
Refer to line 15 on the 2022 Federal Tax Return. If you are under the age of 24 and was unable to answer yes to any of the Dependency Status questions, you must select the income range that combines you and your parent(s) taxable income. If you are married, you must select the range that combines you and your spouse total income.
HOUSEHOLD INFORMATION
Dependent or Independent?*

DependentIndependent
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*
(Section) Status**
SIGNATURE RELEASE:

Authorization: The Educational Opportunity Centers (EOC) Program is funded by the U.S. Federal Department of Education. 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.
Signature*

Clear
* Parent Signature Please Note: If participant is a dependent a parent's or guardian's signature is required.

Clear

SAN JUAN COLLEGE

TRiO

Educational Opportunity Center Participant Application

Educational Opportunity Center
Participant Application