Owens State Community College-EOC-2024 Application Form

Per the Family Educational Rights and Privacy Act (FERPA), information in this application is confidential - we will protect your sensitive personal data. Incomplete applications may be returned to you or rejected.

Full Name:

First NameMiddle InitialLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SOCIAL SECURITY NUMBER:

999-99-9999

Date of Birth

mm-dd-yyyy

Email:

example@example.com

Phone Number

(999)999-9999

Please check the box for the phone number your entered above:

Does this phone number support text messaging?

How would you like us to contact you?

U.S. CITIZEN or PERMANENT RESIDENT?

IS ENGLISH YOUR PRIMARY LANGUAGE?

U.S. MILITARY VETERAN:

GENDER:

RACE

Size of your family household

Family Taxable Income

Did either of your parent (s) or legal guardians complete a 4-year (bachelor) degree program?

What is your current level of education?

I AM INTERESTED IN:

I authorize the exchange of information between the Educational Opportunity Center (EOC) and other agencies, as necessary to assist me in achieving my educational goals. By signing and submitting this application, I certify that the information provided is complete and correct in every respect.

Name

First NameLast Name

Signature:

Date

mm-dd-yyyy

EOC 2024 Application Form