Gaston College-EOC-Application Form

TRiO/EOC Application

Gaston College

Building Better Lives!
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Program Mission

TRiO/Educational Opportunity Center (EOC) sponsored by Gaston College is committed to increase access and resources to education for individuals in Cleveland, Gaston, and Lincoln counties.

Eligibility

An individual is eligible to participate in our program if the individual meets the following requirements:
- Is a resident of Cleveland, Gaston, or Lincoln County?
- Is a citizen or national of the United States, a permanent resident of the United States or is in the United States for other than a temporary purpose and provides evidence from the Immigration and Naturalization Service of his or her intent to become a permanent resident.
TRIO/EOC Gaston College Services
- Guidance on secondary school re-entry or entry to an Adult High School (AHS) program or a High School Equivalency (HSE) program.
- Help in completing applications for college admissions, testing, and financial aid.
- Career counseling and workshops.
- Academic advice.
- College pre-admission counseling.
- Specialized assistance for veterans, military affiliated members.
- Information on postsecondary education opportunities and student financial assistance.
- Specialized assistance for homeless or foster youth.
- Education or counseling services designed to improve the financial and economic literacy of students.
- Tutoring
TRiO/Educational Opportunity Center is federally-funded by the U.S. Department of Education in cooperation with Gaston College. Gaston College is an equal opportunity educator and employer.
TRiO/Educational Opportunity Center
Date of Application

MonthDayYear
mm-dd-yyyy
Legal Name*

First NameMILast Name
Preferred Name
Date of Birth*

MonthDayYear
mm-dd-yyyy
Social Security Number*
999-99-9999
Personal Email Address*
example@example.com
Male or Female?*

MaleFemale
Preferred Pronoun
High School name and Year Graduated
From which did you graduate:*

AHSHSEGEDTraditional High SchoolHome SchoolNone of the above
Cell Phone Number*
(999)999-9999
Text Messages*

YesNo
Home Phone Number
(999)999-9999
*We will leave messages and/or text messages at the number provided unless otherwise instructed.
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Race/Ethnicity (Check all that apply)*

Hispanic/LatinoAmerican Indian/Alaska NativeAsianCaucasian/WhiteNative Hawaiian/Pacific IslanderBlack/African America
Residency Status (Check all that apply)*

U.S. CitizenPermanent ResidentNon-ResidentCleveland County ResidentGaston County ResidentLincoln County Resident
Needs and Service Assessment - (Check all services you are interested in learning more about.)*

Obtain a High School Degree or EquivalencyEarn an Associate's DegreeEarn a CertificateEarn a DiplomaUndecidedCollege Selection/Application GuidanceCourse Selection/Registration AssistanceCareer PlanningFAFSA Application AssistanceIndividual SupportStress ManagementSubstance AbuseAnxiety/Depression
Primary Language*
How did you hear about TRiO/Educational Opportunity Center?

InstructorStaff MemberEmailFlyerPresentationTRiO Student
Name of TRiO Student
Have you ever applied to attend a Community College or a University?*

YesNo
Have you applied for financial aid?*

YesNo
Are you currently working?

YesNo
Number of hours working per week
Military Status

Active MilitaryVeteranMilitary ReserveNone of the Above
First Generation Status - Did the parent(s)/guardian(s) you lived with while attending high school have a 4-Year college degree?*

YesNo
Disability Status - Do you have a documented disability?*

YesNo
Check the amount that most closely matches your family's taxable income last year.*

$23,475$23,476 - $31,725$31,726 - $39,975$39,976 - $48,225$48,226 - $56,475$56,476 - $64,725$64,726 - $72,975$72,976 - $81,225More than $81,225
Select the number of people supported by that income (household size including yourself).*

12345678Other
As of today, what is your level of education?*

I graduated from High School, AHS, HSE or completed a GEDI am currently a High school Senior in 12th GradeI have NOT completed a High School degree or equivalency.I am currently a college or university student enrolled in classesI have completed some college classes, but I am not currently enrolled in classesI am a college student seeking to transfer to another college or universityI possess a college or university degreeOther
Permissions*

Permission to Print NamePermission to Print PhotoNeither Print Name or Print PhotoI give TRiO/EOC permissions to access and release information on my behalf for reasons listed above.I DO NOT give TRiO/EOC permission to access and release information on my behalf for reasons listed above.
I certify that the information I have provided on this application is, to the best of my knowledge, true and correct. Furthermore, I understand that by applying for this program, I authorize the Gaston College TRiO/EOC Program to release information as required by law or the terms of the EOC Grant, to the grant funding agency of the federal government. This information will be kept confidential and used only by TRiO/EOC to verify eligibility.
Student Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Release of Information – All student information at TRIO/EOC is kept confidential and will not be released without your permission. TRiO/EOC would like your permission to access and release your information related to grant objectives and promotion. Please review and check all scenarios where you give TRiO/EOC permission to access/release information pertinent to the implementation of the TRiO/EOC grant.

TRiO/EOC must report student enrollment and eligibility information regarding enrollment to an institution of higher learning to the U.S. Department of Education to demonstrate program effectiveness when submitting annual performance reports and requesting renewed funding.The Financial Aid Office of the college you select will provide us eligibility information and Financial Aid Award information with your permission.We like to recognize student achievements. Do you grant permission to include your name or picture for program related publicity, exhibits or displays? Please indicate a preference by checking below: