Highland Community College-Freeport-EOC-Dependent Income Form

TRIO Educational Opportunity Centers

Educational Attainment & Income Form – DEPENDENT Student 2022-2023
To Be Completed by the Student’s Parent/Legal Guardian

The following information is used to determine eligibility for Educational Opportunity Centers (EOC). Please complete and sign all sections in ink or type. EOC is federally funded by the Department of Education for $232,050 and requires that we report statistics about the students we serve.
Student’s Name:*

First NameLast Name
Name of Parent/Legal Guardian:*

First NameLast Name
Parent/Legal Guardian Phone No:*
(999)999-9999
Parent/Legal Guardian Email*
example@example.com
Eligibility

A student is eligible to participate in Educational Opportunity Centers if the student is: a citizen, national, or permanent resident of the U.S., AND is a low-income, first generation college student:
Is student a citizen or national of the United States?*

YesNo
Did either one of the natural or adoptive parents of the student earn a baccalaureate degree?*

YesNo
If prior to the age of 18 the student regularly resided and received support from only one parent, did that parent receive a baccalaureate degree?*

YesNoN/A
Number of people living in parent/legal guardian’s household?*
What was your family's taxable income for last year?*
Taxable income is not the same as gross or adjusted gross income. Look at the following line on your taxes for last year: Form 1040 -line 15. If you did not file taxes for last year, your taxable income is $0.
Certification:*

I certify that the information I have reported is accurate to the best of my knowledge.
Parent/Legal Guardian Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy

TRIO Educational Opportunity Centers