Alamo Colleges District-EOC-Application Form

Name

First NameMiddle NameLast Name

Today's Date

mm-dd-yyyy

Where did you hear about EOC?

Are you fluent in English

Address

Address & Apartment #

Street Address Line 2

CityState / Province

Postal / Zip Code

Cell Phone Number

(999)999-9999

Email Address

example@example.com

Date of Birth

mm-dd-yyyy

Gender

Ethnicity (Select only one)

Race (Select all that apply regardless of Ethnicity)

Citizenship

If Permanent Resident, A#

Did either of your parents graduate from college with a 4-year college degree?

Dependency Status: (Please check all that apply to you)

Did you check ANY of the Dependency Status boxes above?

Number of Family Members in Your Household?

Include yourself, your spouse, your children, and any other individual who is receiving more than half of their support from you.

Income Statement - Your Taxable Income for the previous year was the following:

Student (and Spouse) Taxable Income

Number of Family Members in Your Household?

Include your parents, yourself, you parents' other children, and any other individual who is receiving more than half of their support from your parents.

Income Statement - Your Taxable Income for the previous year was the following:

Parent(s) Taxable Income

(Note: Taxable income is not less than adjusted gross income and is listed on federal tax returns)

Alamo College District's Educational Opportunity Center (EOC) is a federal TRIO Project funded 100% by the US Department of Education to serve 850 Participants on an annual federal budget of $232,050.

What are your Current Educational Goals?

College(s) Considering:

1.

2.

I am undecided on College Considering

Degree Programs(s):

1.

2.

I am undecided on my Degree Program

Intended Career Field:

I am undecided on my Career Field

Have you ever received services from a TRiO EOC Project before?

Which year?

Have you participated in any of the following programs SINCE SEPTEMBER 1? (Check all that apply)

Current Education Status: (Please check you current educational status. Please check only one.)

High School Non-Senior (grades, 9, 10, or 11) - High School:

High School Non-Senior (grades, 9, 10, or 11) - Grade:

High School Senior - High School:

High School Senior - Class of:

High School Stop out - High School:

High School Stop out - Check as many as apply

Enrolled in an Alternative Education/GED Program - Program Name:

High School Graduate - High School:

High School Graduate - Year Graduated:

Earned GED - Year Earned:

Earned GED - Program Name:

College Student - Currently enrolled at:

College Student - # of Hours/Years:

College Student - Major:

College Student - Are you interested in transferring to another college?

College Stop out - Last College attended:

College Stop out - Semester/Year

Postsecondary Certificate Earned (1 Year) - Year Earned:

Postsecondary Certificate Earned (1 Year) - College:

College Graduate - Degree(s) Obtained:

Other

College Graduate - Degree(s) Obtained - Associate Degree (2 year) - Year Earned:

College Graduate - Degree(s) Obtained - Associate Degree (2 year) - Major:

College Graduate - Degree(s) Obtained - Bachelor's Degree (4 year) - Year Earned:

College Graduate - Degree(s) Obtained - Bachelor's Degree (4 year) - Major:

Military-Connected (Check any that apply)

College Admissions Application Status:

I have completed a completed a college admission application to...

Semester/Year:

Student Financial Aid Application

Semester/Year

EOC helps you plan your education future. Which of the following services would be helpful to you? (Check all that apply)

Financial Aid Assistance

College Admissions Assistance

Other

Consent:

I certify that the information I have reported on pages 1 through 3 of this Intake & Assessment Form, including my taxable income and parents’ education level, is accurate to the best of my knowledge. I authorize the EOC Project to have access to my high school and college information necessary to determine program eligibility, assist, and verify college enrollment. This includes my grades, test scores, enrollment status, and student financial aid records, and to release information from my Participant file to state and federal agencies when required by law or regulations.

I would like to receive text messages regarding my appointments, deadlines, scholarships, and other necessary communication.

Best Phone Number

Participant Signature

Date

mm-dd-yyyy

Parent Signature (Only required for Dependent Students)

Date

mm-dd-yyyy