Alamo Colleges District-EOC-Application Form

Name*

First NameMiddle NameLast Name
Today's Date

MonthDayYear
mm-dd-yyyy
Where did you hear about EOC?
Are you fluent in English

YesNo
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

MonthDayYear
mm-dd-yyyy
Gender

MaleFemaleNonbinary or another genderUnknown/No Response
Ethnicity (Select only one)

Hispanic/Latino (Mexican, Puerto Rican, Cuban, OR Central/South American, or other Spanish cult)Non-Hispanic/Latino
Race (Select all that apply regardless of Ethnicity)

American Indian or Alaskan NativeAsian, Japanese, Chinese, Vietnamese, Korean, FilipinoBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite, Anglo, Caucasian
Citizenship

US CitizenPermanent ResidentNeither
If Permanent Resident, A#
Did either of your parents graduate from college with a 4-year college degree?

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

As of Today, you are at least 24 years oldCurrently Married or SeparatedHave children or have other dependents who receive more than 1/2 of their support from youUS Armed Forces veteran or on active dutyIn foster care, ward of the court, or both parents deceasedEmancipated minor or in a legal guardianshipUnaccompanied/Homeless YouthHave completed a 4-year college degree and working on master's or doctorate degree
Did you check ANY of the Dependency Status boxes above?

Yes = You are an Independent StudentNo = You are a Dependent Student
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?

Unknown/UndecidedHigh School DiplomaGED/High School EquivalencyCertificateAssociate DegreeBachelor's DegreeMaster's DegreeDoctorate Degree
College(s) Considering:
1.
2.
I am undecided on College Considering

YesNo
Degree Programs(s):
1.
2.
I am undecided on my Degree Program

YesNo
Intended Career Field:
I am undecided on my Career Field

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

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

Not ApplicableTRIO Upward BoundTRIO Upward BOUND Math & ScienceTRIO Student Support ServicesTRIO Talent SearchTRIO Veterans Upward BOUNDGEAR UPAnother federal program
Current Education Status: (Please check you current educational status. Please check only one.)

High School Non-Senior (grades 9, 10, or 11)High School SeniorHigh School Stop outHigh School GraduateEarned GEDCollege StudentCollege Stop outPostsecondary Certificated Earned (1 Year)College Graduate
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

Dropped out in 9th GradeDropped out in 10th GradeDropped out in 11th GradeDropped out in 12th GradeNot enrolled in an Alternative Education/GEDEnrolled 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?

YesNo
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:

Associate Degree (2 year)Bachelor's Degree (4 year)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)

Not ApplicableVeteranSpouse of Active Duty MilitaryActive Duty MilitaryChild of Active Duty Military
College Admissions Application Status:

I have completed a college admission applicationI have not applied yetNot Applicable
I have completed a completed a college admission application to...
Semester/Year:
Student Financial Aid Application

I have completed a financial aid and/or scholarship applicationI have not applied yetNot Applicable
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

Financial Aid Application (FAFSA)Loan ApplicationLoan DefaultScholarship AssistanceFinancial Aid VerificationBudgeting for CollegeOther
College Admissions Assistance

Admissions ApplicationApplication Fee WaiverCollege SearchTesting Fee WaiverTransfer AdvisingCollege Re-entryOther
Other

Academic PlanningCareer AdvisingGED/High Scholl EquivalencyHigh School Re-entryCollege credit for work experience and trainingEmployability SkillsOther
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.

YesNo
Best Phone Number
Participant Signature

Clear
Date

MonthDayYear
mm-dd-yyyy
Parent Signature (Only required for Dependent Students)

Clear
Date

MonthDayYear
mm-dd-yyyy