Southern University-Shreveport-EOC-Application Form
  • Caution

  • Participation Application

  • Date of Birth
     - -
  • Do you consider yourself to be Latino/Hispanic?
  • In addition, select one or more for the following race categories to describe yourself
  • Gender
  • Do you speak a language, other than English, as your primary language?
  • Did your birth or adoptive parent(s) that you resided with prior to age 18 earn a Bachelor's Degree?
  • Are you a U.S citizen? (If checked yes, skip to thirteen.)
  • If not, are you a permanent resident of the U.S.?

  • Dependency Information:

  • Family Taxable Income from last year?
  • Household funding sources?
  • Were you a foster child or ward of the court before you turned 18?
  • Are you a veteran?
  • Is your parent, guardian, or spouse serving in active duty or a veteran?
  • Do you have a documented Disability?
  • What is your current education level?
    • Academic needs assessment 
    • I would like assistance with:

    • I acknowledge that my participation is voluntary and the information provided is accurate to my knowledge. By signing, I consent to EOC submitting applications (admission, HiSET, financial aid, etc.) on my behalf. I authorized the release of test scores, transcipts, admission, and other relevant information that could assist the educational Opportunity Center to meet my academic needs.

      Media Authorization: I authorize EOC to use photographs and/or videotap with my image in Educational opportunity Center publicity, promotional medica, social media, websites and/or news releases.

    • Indicate

    • Southern University at Shreveport does not discriminate on the basis of race, color, national origin, gender, age, disability, or any other protectedclass. For Title IX inquiries, contact Tilisha T. Bryant, Title IX Coordinator at titleix@susla.edu. Contact the ADA Coordinator, Tilisha Bryant, at tbyrant@susla.edu.

    • Clear
    • Clear
    • Date
       - -
  • Should be Empty: