The Texas Southern University Educational Opportunity Center is a program sponsored by the U.S. Department of Education that provides FREE post-secondary planning assistance to program eligible participants. In order to better serve you,
PLEASE COMPLETELY FILL OUT THIS FORM. If you have any questions, please feel free to ask an EOC counselor at 713-313-7113 or via email at
trioeoc@tsu.edu
.
Please note that use the "Chrome" browser if you use the mobile device.
DEMOGRAPHIC INFORMATION
How did you hear about us?
*
College/career fair
Community agency
Friend/family
High school counselor
Social Media
TSU Website
Other
What agency/school are you from/affiliated with?
*
Name
*
First
Middle
Last
Birthdate
*
Gender
*
Male
Female
Race/Ethnicity
*
Hispanic or Latino
American Indian or Alaska Native
Asian
Black or African American
White
Native Hawaiian or Other Pacific Islander
Two or more races
Citizenship
*
U.S. Citizen
Permanent Resident
Home Address
*
Street Address
City
State / Province / Region
ZIP / Postal Code
Preferred Contact Method(s)
*
Phone or Email
Phone Only
Email Only
Telephone (Home/Cell)
*
Please enter 000-000-0000 if you do not have a phone.
Email
*
ACADEMIC INFORMATION
Current Education Level
*
HS Student
HS Incomplete (No HS Diploma or GED)
HS/GED Graduate
College Incomplete (did not receive a degree)
College Student
Associates Degree (AA)
College Graduate
Bachelors Degree (BA)
Graduate Degree
Grade
*
College Name
*
Do you have difficulty in speaking English? / ¿Tienes dificultad para hablar inglés?
Yes
No
Military Connected Individuals: If applicable, please select one of the following
None
U.S. Veteran
On active military duty
A spouse of active duty Armed Service Member
A child of an active duty Armed Service Member
Did either parent graduate from a four - year college?
*
Yes
No
Are you currently being served by another TRIO program?
*
Talent Search
Upward Bound
SSS
Others
No
Educational Goal(s): Please list any educational goals or careers that you are interested in pursuing.
What College(s) or Vocational/Trade School(s) are you considering?
*
Please check one box to verify income
*
What was your family's taxable income (not total income) from the last calendar year? Please verify by using information obtained from a governmental source (ex. a signed financial aid application, income tax return, etc.). If utilizing a signed income tax return (either from the US or Puerto Rico) as proof, the information can be found on IRS Tax Form 1040 Line 43, 1040A Line 27, 1040EZ line 6. In accordance with section 725 of the McKinney - Vento Homeless Assistance Act, individuals who are foster care youth (including youth in foster care and youth who have left foster care after reaching age 13), or homeless children and youths' are excluded from this requirement. If you are under the age of 18, please obtain the information from a parent/guardian.
$0 - $18,735
$18,736 - $25,365
$25,366- $31,995
$31,996 - $38,625
$38,626 - $45,255
$45,256 - $51,885
$51,886 - $58,515
$58,516 - $65,145
$65,146+
Number of family members supported by that income: (including yourself)
*
Please enter a value between
1
and
12
.
I would like assistance with the following (Check all that apply)
*
GED Information
College/Univ./Trade/Vocational School Admissions
Financial Aid/FAFSA
Career Information
Locating a college or vocational school
Scholarships
Other
Please write down the details
REGULATIONS
Photo/Media Release : ( Parental s ignature r equired if under the age of 18 )
Much of our publication and marketing success is from the use of photos and videos taken of EOC participants during program events. Unless you choose to “Opt Out” of this release, by signing below, you also give the irrevocable right for the EOC program to use your name, photo, or video in all forms and media and in all manners, including composite or distorted representations, for advertising, trade or any other lawful purposes, and you waive any right to inspect or approve the finished version(s), including written copy that may be created in connection therewith.
OPT OUT
Text Message Release: ( Parental signature required if under the age of 18 )
Unless you choose to “Opt Out” of this release, the EOC program would like utilize text/SMS messaging services to alert you of important timelines, events, and scholarships/FAFSA deadlines until such time as I notify the EOC program to discontinue this service.
OPT OUT
FERPA Certi fication and Release:
The Family Educational Rights and Privacy Act or FERPA, was enacted to protect the privacy of student records. By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the my official academic records to the Educational Opportunity Center (EOC), understanding that the information in these records will be used only to assess the need for program services, to evaluate the effectiveness of program activities, and to fulfill program-reporting requirements until such time as I revoke this release by notifying the EOC program in writing. Furthermore, I hereby give the EOC permission to forward my information to other programs and or departments whose services will best meet my needs.
Applicant Signature
*
Press and hold the left mouse button in the box and draw your signature.
If you want to delete it and try again simply press "Clear" icon in the bottom right corner.
Date
*
Parent/Guardian Signature required if under the age of 18
Press and hold the left mouse button in the box and draw your signature.
If you want to delete it and try again simply press "Clear" icon in the bottom right corner.
Date
Please type the words or numbers in the box. If you want to delete it and try again simply press "Clear" icon in the top right.