FCEA EOC Application

Do you need to complete a GED or High School Diploma?

Do you need assistance with college or certification program enrollment?

Do you need help with Financial Aid or Economic Literacy?

Do you need help with employment or training opportunities?

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Name

First NameMiddle InitialLast Name

Address

Street Address

Apt. #

CityState / Province

Postal / Zip Code

Home Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Cell Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email

example@example.com

What is your major (if applicable)?

What is your student ID number (if applicable)?

What is your birthdate?

Are you Hispanic or Latino?

What is your race?

What is your gender?

Are you a U.S. citizen?

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?

Has your father received/earned a 4-year college degree?

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.)

Are you married?

Do you have children or other dependents (other than a spouse) who receive more than half of their support from you?

At any time since reaching 13 years of age, were you an orphan, in foster care, or a ward of the court?

Prior to reaching 18 years of age, were you an emancipated minor or did you have a court-appointed legal guardian?

Are you serving on active duty (for other than training purposes) in the U.S. Armed Forces?

Are you a U.S. Armed Forces veteran who was on active duty & was released under a condition other than dishonorable?

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?

Are you less than 18 years of age and have no parent or guardian?

Are you homeless (i.e., you lack a fixed, regular, & adequate nighttime residence) or are at risk of becoming homeless?

What is the total number of persons (including you) in your family?

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.

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.

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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