Educational Opportunity Center Intake & Assesment

Personal Data

Were you born before January 1, 2002? If so, only you need to sign the intake form. If your were born after January 1, 2002, Both you and a parent must sign the intake form unless:

• You are currently serving on active duty in the U.S. armed forces for purposes other than training.
• You are a veteran of the U.S. armed forces.
• You have children or other people (excluding your spouse) who live with you and receive more than half of their support from you now and between July 1, 2025, and June 30, 2026.
• At any time you turned 13, you were an orphan ( no living biological or adoptive parent).
• At any time since you turned 13, you were a ward of the court.
• At any time you turned 13, you were in foster care.
• You is or was a legally emancipated minor, as determined by a court in your state of residence.
• You is or was in a legal guardianship with someone other than your parent or stepparent, as determined by a court in your state of residence
• You are married (not separated).

If one of your parents need to sign this form, please include their email below.

Ethnicity and Citizenship

Family and Military

Income

If you do not file taxes, please select $0 - $22,590.

Services Needed

Educational Status

Other TRIO Programs

Affidativit of Truth Statement

I certify the income statement and additional information I have reported on of this Intake & Assessment Form are accurate to the best of my knowledge.

I authorize the TRIO EOC

• to have access to my high school and college information necessary to determine program eligibility , status and student financial aid records.
• to release information from my participant file to state and federal agencies when required by law or regulations.

In an effort to provide the best service possible, an Individualized College Success Roadmap will be part of the service. A copy will be provided to you.