Family Centered Educational Agency
Educational Opportunity Center-Participant Application
Do you need to complete a GED or High School Diploma?
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Yes
No
Do you need assistance with college or certification program enrollment?
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Yes
No
Do you need help with Financial Aid or Economic Literacy?
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Yes
No
Do you need help with employment or training opportunities?
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Yes
No
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Name
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First Name
Middle Initial
Last Name
Address
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Street Address
Apt. #
City
State / Province
Postal / Zip Code
Home Phone Number
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Please enter a valid phone number.
Cell Phone Number
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Please enter a valid phone number.
Email
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example@example.com
What is your major (if applicable)?
What is your student ID number (if applicable)?
What is your birthdate?
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Are you Hispanic or Latino?
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Yes
No
What is your race?
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American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
What is your gender?
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Female
Male
Are you a U.S. citizen?
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Please Select
Yes
No, but I am a Permanent Resident
No, I am not a U.S. citizen, and I am not a permanent resident.
If you are a Permanent Resident; please enter you Permanent Resident Alien Number including the A it begins with:
Has your mother received/earned a 4-year college degree?
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Yes
No
Has your father received/earned a 4-year college degree?
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Yes
No
Which parent did you regularly reside with and receive support from during your childhood (i.e. until you were 18 years old)? (Please check only one box.)
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Both Mother and Father
Neither Mother nor Father
Mother Only
Father Only
Are you married?
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Yes
No
Do you have children or other dependents (other than a spouse) who receive more than half of their support from you?
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Yes
No
At any time since reaching 13 years of age, were you an orphan, in foster care, or a ward of the court?
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Yes
No
Prior to reaching 18 years of age, were you an emancipated minor or did you have a court-appointed legal guardian?
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Yes
No
Are you serving on active duty (for other than training purposes) in the U.S. Armed Forces?
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Yes
No
Are you a U.S. Armed Forces veteran who was on active duty & was released under a condition other than dishonorable?
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Yes
No
Are you currently working on a master's (e.g., M.A., M.S.), professional (e.g., M.D.m J.D.) or doctoral degree?
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Yes
No
Are you less than 18 years of age and have no parent or guardian?
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Yes
No
Are you homeless (i.e., you lack a fixed, regular, & adequate nighttime residence) or are at risk of becoming homeless?
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Yes
No
What is the total number of persons (including you) in your family?
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My family's taxable (not total) income from the last calendar year was:
Note: Taxable income 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.
I attest that my family did not file a federal income tax return for the last calendar year.
I attest that my family had no taxable income during the last calendar year and that the information that I provided above is accurate.
If possible, can you upload a copy of your 1040 tax return, your medical card, or your SNAP benefits letter? This can be sent through PDF or in a simple screenshot. Providing us with this information allows us to determine your income eligibility for the program.
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Participant's Signature: By signing this application, I attest that all the information on this application is true. Moreover, I authorize the release of the student's official academic records to the FCEA-EOC project, understanding that the information in these records will be used only to assess the student's need for TRIO program services, discern the student's educational progress, evaluate the effectiveness of TRIO program activities, and fulfill TRIO program reporting requirements. Finally, I authorize the FCEA-EOC project to use the participant's name, statements and likeness, without charge, for promotional purposes in the project's publications, advertising, video, and other formats.
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Parent Signature: By signing this application, you attest that all the information on this application is true. Moreover, you authorize the release of official school records to The Family Centered Educational Agency, understanding that the information in these records will be used only to assess the student’s need for program services, discern his/her educational progress, evaluate the effectiveness of program activities, and fulfill program reporting requirements. Also I authorize for any pictures/videos taken in connection with the activities of the FCEA TRIO Programs to be used in publications.
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How did you hear about us?
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Facebook
Instagram
Snapchat
Word of Mouth
Our Website
Other
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