• Educational Opportunity Center (EOC)

    Participant Intake Form
  • Date*
     - -
  • Date of Birth:*
     - -
  • Age:*

  • *All sections need to be filled out to determine eligibility for EOC services. All information on this form will be used for EOC purposes. Your personal information will be kept confidential.

    Please complete with the most current and accurate information.

  • Please select:*
  • Ethnic Background:*
  • Is English your primary language?*
  • Are you a US citizen or legal resident?*
  • Marital Status*
  • Were/are you a ward of the court, state or foster care at any time since age 13?*
  • Military Connected*
  • Do you have a documented disability?*
  • If yes, please check all that apply:
  • What is your total household size?*
  • Taxable household income range last year:*
  • Do you have any children or other dependents who rely on you financially?*
  • Last year did your household receive?
  • Did either of your parents receive a 4-year bachelor’s degree?*
  • Are you currently in a GED or high school diploma program?*
  • What is your highest level of education?*
  • Did you drop out of college or a vocational school before receiving a degree or certificate?*
  • Have you applied for financial aid?*
  • Services you would like to receive*
  • Who referred you to our program?

  • Please read each statement below, then sign and date.

    I give permission to the Educational Opportunity Center program and staff to obtain, review, discuss and copy all records and information available through my previous schools (high school, college/university, etc.) including but not limited to academic records, financial aid records and to release information to the U.S. Department of Education and Delta College. All information obtained by the Educational Opportunity Center is completely personal and confidential and will only be used for verification of eligibility to this program.

    The Educational Opportunity Center program and staff have my permission to communicate verbally, in writing, by email, or other means to share information with Delta College faculty, staff, departments, and/or off-campus professionals.

    The Educational Opportunity Center program and staff have my permission to submit on an annual basis my name, date of birth, and social security number to the National Student Clearinghouse to verify enrollment and degree information

    Being permitted to participate in activities and usage of equipment and facilities, I agree to indemnify and hold harmless the Educational Opportunity Center program and Delta College from any and all claims which are in any way connected with
    such use or participation in the program.

    I certify that all information provided on this intake form is true and complete.

  • Clear
  • Date:*
     - -

  • Please click the link below to schedule a virtual or in-person appointment with an advisor.

    https://outlook.office365.com/owa/calendar/EducationalOpportunityCenter@deltac.onmicrosoft.com/bookings/

    Have Questions?

    989-686-9470 – EOC@delta.edu – www.delta.edu/eoc

    It is the policy of Delta College and the Educational Opportunity Center not to discriminate in employment, education, public accommodation or public service on the basis of religion, race, color, national origin, age, sex, marital status, sexual orientation, gender identity, height, weight, arrest record, veteran status, disability, or other classifications as required by applicable U.S. federal, state or local law. Direct inquiries to the Equity/Compliance Officer, Delta College, 1961 Delta Road, Equity Officer/Title IX Coordinator, Office J101, University Center, MI 48710, telephone 989-686-9247, or email: equityoffice@delta.edu. 18-276 (5/19)

     

    TRiO EOC is funded through a grant from the U.S. Department of Education

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