Wahupa Educational Enterprises, Inc.-EOC-Application Form

COLLEGE & CAREER COUNSELING SERVICES INTAKE

What school do you currently attend?*
MAACChula Vista Adult SchoolMontgomery Adult SchoolNational City Adult SchoolSan Ysidro Adult SchoolPalomar High SchoolBayfront High SchoolSecond ChanceCEOWahupa
Name:*

First NameMILast Name
Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date*

MonthDayYear
mm-dd-yyyy
MaleFemale
Social Security Number:
999-99-9999
Email:*
example@example.com
Home Number:*
(999)999-9999
Cell Number:*
(999)999-9999
YesNo
Some high school or belowEarned high school diploma or equivalencySome collegeEarned bachelor’s degree or beyond (in the U.S.)
Not enrolled in classesEnglish as a Second language (ESL)High school diplomaHigh school equivalency (HiSET/GED)Adult school reading, writing, math classesCareer Technical Education (CTE)College courses
if so, what college and/or courses?
YesNo
U.S. CitizenLegal Permanent ResidentApplication Pending for Resident StatusNone Applies
YesNo
American Indian/Alaska NativeAsianBlack/African AmericanPacific Islander/Native HawaiianWhiteHispanic/Latino
SingleMarriedSeparatedDivorcedWidowed

If you are 24 years of age or older, please mark "N/A" to the following questions. If you are 23 years of age or younger, please check YES or NO to the following questions:*

Rows	Yes	No	N/A
A) Are both of your biological parents deceased?
B) Do you have children or dependents who receive more than half of their support from you?
C) Are you currently serving in the U.S. Armed Forces (military)?
D) Are you or were you an emancipated minor or in legal guardianship as determined by the court?
E) Are you homeless or at risk of being homeless?
F) Did you graduate from a four-year university and will you attend graduate school this year?
G) Are you or were you a foster child/ward of the court?

If you answered NO to all of the above questions, please submit a “Parent Supplement Form”
Non-MilitaryVeteranActive duty militarySpouse of active duty militaryChild of active duty military
YesNo
What was your (and your spouse’s) taxable income last year (Jan.-Dec.)? *
Number in household (including yourself, spouse, and children)*
Vocational schools or college informationFinancial aid informationFinancial planning & money management informationPlanning career goals and/or career interest testingCollege and/or financial aid application assistanceCollege assessment test informationHigh School Diploma/GED/HiSET informationTutoring
YesNo
I understand that the information provided above is kept strictly confidential and is used to establish eligibility for free TRIO/EOC services. I authorize the National Student Clearing house to release my post-secondary enrollment information, with and without a Social Security number. I authorize my counselor to obtain information regarding my secondary/post-secondary enrollment and financial aid status. I agree that my awareness of financial aid and postsecondary information is limited, and I can benefit from EOC services. I am currently not participating in any other TRIO programs. I certify that all my responses are correct to the best of my knowledge.
Signature*

Clear
Date*

MonthDayYear
Date

COLLEGE & CAREER COUNSELING SERVICES INTAKE