University Of Texas-Arlington-EOC-Application Form

EDUCATIONAL OPPORTUNITY CENTER

2024-2025 Application
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Today's Date:*

MonthDayYear
mm-dd-yyyy
Name:*

First NameMILast Name
SSN:
999-99-9999
Date of Birth:*

MonthDayYear
mm-dd-yyyy
Are you 19 years of age or older?*

YesNo
Age:*
Gender:*

FemaleMaleTrans-FemaleTrans-MaleNon-BinaryPreferred response
What pronouns do you prefer?
Do you currently reside in Tarrant or Dallas County?*

YesNo
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Telephone:*
(999)999-9999
E-Mail:*
example@example.com
Marital Status:

SingleMarriedSeparatedDivorcedWidowed
Are you Hispanic or Latino?*

YesNo
Race:*

American Indian or Alaska NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhite
Are you a U.S. Citizen?*

YesNo
If no, do you have permanent resident status?*

NoYes
A#:*
What is the highest level of education you’ve completed? (Please check only one)*

I am currently attending high schoolI have received a high school diplomaI have completed my GEDI have enrolled in a GED programI do not have a high school diploma or GEDI am currently attending collegeI attended college but did not graduateI have received an Associate's DegreeI have received a Bachelor's Degree
Where are you currently attending High School?*
Grade Level?*
High School Diploma: Month/Year:*
High School Diploma: School Name, City, State:*
Completed GED: Where?*
Completed GED: Date:*

MonthDayYear
mm-dd-yyyy
Enrolled in GED: Where?*
Where did you attend High School?*
Where are you attending college classes?*
Where did you attend college classes?*
Which degrees do you have?*

Associate'sBachelor's
Please note: The following information is required by the Department of Education to establish program eligibility.
Number of people in your household. (Include yourself) TOTAL:*
Do either of your parents have a bachelor's degree?*

YesNo
What is your household income?*

$0 - $22,590$22,590 - $30,660$30,660 - $38,730$38,730 - $46,800$46,800 - $54,870$54,870 - $62,940$62,940 - $71,010$71,010 - $79,080$79,080 and above
Did you/your guardian file a tax return last year? (If under the age of 24 and dependent did your parent(s) file taxes last year?*

YesNo
Are you a Veteran of the U.S. Armed Forces?*

YesNo
Are you or your spouse currently on active duty?*

YesNo
Are you a child of an active-duty service member?*

YesNo
Are you currently employed?

YesNo
Do you receive any of the following? (Please check all that apply)

Social SecurityDisability or SSIVA/GI BillChild SupportTANFSNAPUnemploymentReduced/Free LunchWICOther
How or where did you hear about the Educational Opportunity Center?*
Have you ever participated in other TRIO Programs?*

NoYes
If yes, please check all that apply:

Educational Opportunity CenterEducational Talent SearchUpward BoundMcNair ScholarsUpward Bound Math/ScienceVeteran's Upward BoundStudent Support Services
How can the Educational Opportunity Center help you? Please check all that apply.*

GED Information/ReferralCareer GuidancePlacement Test PreparationAdmission AssistanceFinancial Aid/Scholarship AssistanceTransfer to another college/universityMoney Management SkillsEducational Advising
What are your career and educational interests?
What school(s) are you interested in?
Certification:

My signature below certifies that the above information is correct and that I desire to pursue a program of postsecondary education. I grant the Educational Opportunity Center permission to send for/receive copies of transcripts, financial aid awards, FAFSA, test scores, and other relevant income or additional information necessary for participation in the program and allow state and federal agencies permission to release income information.
Signature:*

Clear
Date:*

MonthDayYear
mm-dd-yyyy
Participants under 19 years of age.
Parent's Signature:*

Clear
The information that UTA collects will be retained as required by Texas records retention in conjunction with federal regulations established by the US Dept. of Education. The US Dept. of Ed. Requires the EOC to give priority to low-income individuals, neither of whose parent has a bachelor’s degree. Must be a U.S. citizen or permanent legal resident age 19 years or older residing in Dallas or Tarrant County. The University of Texas at Arlington does not discriminate on the basis of race, color, national origin, religion, age, gender, sexual orientation, disabilities, genetic information, and/or veteran status in its educational programs or activities it operates. For more information, visit www.uta.edu/eoc. For information regarding Title IX, visit uta.edu/titleix

EDUCATIONAL OPPORTUNITY CENTER