University Of Tennessee-Knoxville-EOC-2023 Application Form

Authorization for EOC Services and Confidential Financial Statement
Applicant Information
Full Name:*

First NameM.I.Last Name
Date of Birth:*

MonthDayYear
mm-dd-yyyy
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone:*
(999)999-9999
Email:*
example@example.com
Ethnicity:*

American Indian or Alaska Native, non-Hispanic/LatinoAsian, non-Hispanic/LatinoBlack or African American, non-Hispanic/LatinoHispanic/Latino of any raceNative Hawaiian or other Pacific Islander, non-Hispanic/LatinoTwo or more races, non-Hispanic/LatinoWhite, non-Hispanic/Latino
Gender:*

FemaleMale
Are you a U.S. Citizen?*

YESNO
If NO, are you a Permanent Resident or intend to become a Permanent Resident? (You will be required to provide documentation)*

YESNO
If NO, please provide your permanent resident number
Did either of your parents earn a Bachelor's Degree before you were 18 years of age (biological or adoptive parents with whom you live now or lived with previously)?*

YESNO
Are you military-connected? (Please check any that apply to you)*

VeteranActive Military dutySpouse of Active Military DutyChild of Active Military DutyNo
Are you participating in any other TRIO Program?*

YESNO
If yes, which one?

Talent SearchUpward BoundVeterans Upward BoundGear UpUpward Bound Math and Science
If you are attending a school, what school are you enrolled in? If you are not attending school, please put "not enrolled".*
I plan to attend this college/technical school: (school name)*
What career are you interested in pursuing?*
Please mark the box that most closely describes your current educational status:*

I am a high school seniorI withdrew from a college/technical schoolI am enrolled in a HiSET/GED program or alternative high schoolI have earned a high school diploma or HiSET/GEDI have earned an Associate's DegreeI have earned a Bachelor's Degree or higherI am a current college studentI have earned a technical degree or certificate
Financial Information
Applicants over 24 years of age: Complete the questions below regarding your household size and income.

Applicants under 24 years of age: You may be required to submit your parent's income and their signature. If a parent is not available, parent's documentation may be requested by your Educational Specialist. If you think you are considered an independent student (married, parent, in foster care, veteran, etc.), talk to your Educational Specialist about whose income to report.
Are you considered a financially independent student or a financially dependent student? To determine, check ALL the options that are true for you:

I am 24 years or olderI am marriedAt any time since age 13, were you a ward of the court or in foster careI have a child that I support financiallyI am a legally emancipated minorI am a military veteran or active dutyI am in legal guardianship with someone other than my parent
If you checked any of these boxes, you are considered an independent and you will answer the financial questions about yourself.

If you did not check any of these boxes, you are considered a dependent student, and your PARENT will answer the financial questions and sign this form.
How many family members (including yourself) currently live in your home?
If you know your taxable income (line 15 on IRS form 1040) please write it here:
If you don't know your taxable income, but know your adjusted gross income range, please choose a range below, and we will calculate your taxable income.

$0-$22,590$22,591-$30,660$30,661-$38,730$38,731-$46,800$46,801-$54,870$54,871-$62,940$62,941-$71,010$71,011-$79,080$79,081-$87,150$87,151-$95,220Over $95,220
Did you (or your parents) file income taxes last year?

YesNo
If yes, what was your (or your parent's) filing status?

SingleMarried, filing separatelyHead of HouseholdMarried, filing jointlyQualifying widow/er
Disclaimer and Signature(s)
Applicant and/or parent/guardian signatures below certify the information provided on this application is true and correct to the best of my knowledge, and authorizes UTK EOC to release or request information related to the Applicant's educational processes, including financial aid to and from 1)institutions and entities; 2) parents/guardians of the Applicant; and 3) the National Student Clearinghouse for the purpose of tracking Applicant's post-secondary education program.
Applicant Signature*

Clear
Date*

MonthDayYear
mm-dd-yyyy
Parent Signature (required if student is under age 24 to verify income information)

Clear
Date*

MonthDayYear
mm-dd-yyyy
Which counselor gave you this application?*

Authorization for EOC Services and Confidential Financial Statement

Applicant Information

Financial Information

Disclaimer and Signature(s)