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Educational Opportunity Center Application

Apply for services from the Educational Opportunity Center

1. Applicant contact information
Birth date  
/ /  
Gender  


How did you hear about us?






2. Military
Military service  





3. Citizenship
Citizenship status  




4. Ethnicity/Race
Are you Hispanic or Latino?  


Select all that apply
5. Highest degree earned
Highest degree earned   Please indicate the highest degree you have obtained







Are you currently attending high school?


High school Please indicate which high school you are attending




6. Family education history
Has your mother received a 4-year degree?  


Has your father received a 4-year degree?  


Whom did you reside with until 18 years old?   With whom did you regularly reside with and receive support from until you were 18 years old?






7. Income

Your household's taxable income amount can be found on the federal income tax return.

  • On IRS Form 1040, see line 43
  • On IRS Form 1040A, see line 27
  • On IRS Form 1040EZ, see line 6
Taxable income  



Note: If you are under the age of 18, guardian income information will be needed. A staff member will assist you with this when appropriate.
8. Services
Please indicate any TRIO programs you currently participating in
I would like services to aid in my completion of a High School Equivalency / GED  


Do you wish to enroll in education beyond grade 12?   This could be a college or a technical education institute


Authorization   I hereby authorize the release of all educational records--future and past--to the Penn State SEPA EOC with the understanding that all records will remain private within EOC and the Department of Education.


Withdrawal understanding   I understand that should I drop classes or withdraw from any services in which I have participated through EOC, I may be placed on inactive status or withdrawn from the EOC program.


Note: If you are under the age of 18, a guardian's signature authorizing your participation in this program will be needed. A staff member will assist you with this when appropriate.