Grand Rapids Community College-EOC-Application Form

  • GRCC TRIO Educational Opportunities Center Intake Form

    GRAND RAPIDS COMMUNITY COLLEGE
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    • Personal Information 
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    • Gender*
    • Race/Ethnicity: Are you Hispanic/Latino/Latina?*
    • Please select the race category or categories with which you identify. Select all that apply.*
    • Citizenship*
    • Marital Status:*
    • Military Connected
    • Do you have a disability?*
    • Are there any formal accommodations you need in order to access EOC services?
    • Household Information 
    • Current Yearly Household Income*
    • Do you have children or other people in your household that you support financially?*
    • Were you or are you a ward of the court or state?
    • Were you in foster care at any time since age 13?
    • Are you homeless or at risk of being homeless?
    • Educational Background 
    • Did either of your parents receive a 4-year degree (Bachelor’s degree)?*
    • Are you currently in a GED or High School diploma program?*
    • What is the highest level of education you have completed?*
    • Did you drop out of college or avocational school before receiving a degree or certificate?*
    • Is English your primary language?*
    • If English is not your primary language, do you need English language classes?*
    • What services would you like to receive?
    • Have you applied for financial aid for the current year?*
    • Are you currently participating in any of the following federal TRIO programs?
    • Who referred you to our program?*
    • Agreement and Signature 

    • Read Below and Sign and Date
      Certification and Signatures - To the best of my knowledge, the information that I provided is true, complete and accurate. I authorize the EOC program to release any information contained on this form to any other agency, school, or person that may require such information to assist me in completing my educational plans. I also authorize any school or postsecondary institution that I have attended or may attend in the future to release to Grand Rapids Community College EOC, upon their request, information pertaining to my academic, enrollment, and financial assistance record.

    • Clear
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    • Clear
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    • Optional Media Authorization: I, the under signed, authorize the TRIO Educational Opportunities Center Program at Grand Rapids Community College to use photographs and/or videotape with my image in the Educational Opportunities Center publications, promotional media, social media, websites and/or news releases.
    • Clear
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    • Submit 
    • Should be Empty: