Educational Opportunity Centers Program Application

Participant Information

The University at Albany Educational Opportunity Centers Program is a fully-funded TRIO program of the U.S. Department of Education and is mandated to serve income-eligible individuals who are first-generation/potential first-generation college students.

First Name

Middle Name

Last Name

Birthdate

Social Security Number

Country

Street

City

Region

Postal Code

County

Mobile Phone Number

Do you wish to be contacted via text?

Yes

No

Email Address

Citizenship

Military-Connected (select all that apply)
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Sex

Colleges and universities are asked by many groups, including the federal government, accrediting associations, college guides, and newspapers, to describe the ethnic/racial backgrounds of their students and employees. In order to respond to these requests, we ask you to answer the following two questions.

Hispanic/Latino

Race (select all that apply)
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Financial Information

Employment status

Marital status

Size of household (including yourself)

2022 Taxable Income:

Taxable income is the amount of income used to calculate how much tax an individual owes the government in a given tax year. This is different from your salary or your gross income. In almost every situation, taxable income is less than your gross income. Taxable income can be found on either the IRS Form 1040.

In order to verify your income, please upload the applicable proof of income:

IRS Form 1040 (if you have not filed yet for 2022, you may submit 2021) or
Did not and will not file taxes - Documentation of income, including food stamps, child support, alimony, prior year’s Social Security benefits statement (if you receive Social Security), prior year’s disability benefits statements (if you receive disability), prior year’s military Leave and Earning Statement (LES) (if you are military or retired military).

Educational Information

Do you need help reading or speaking English?

As of today, what is your level of education?

Parents' educational level

Have you participated in other federal TRIO programs?
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What assistance do you need to help you reach your educational and career goals?
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Disclaimers and Signature

I grant the University at Albany, Educational Opportunity Centers (EOC) Program staff, and/or their legal representatives, the irrevocable and unrestricted right to use and publish photographs or recordings of me, or in which I may be included, for editorial trade, advertising, and any other purpose and in any manner and medium; and to alter the same without restriction. I will not seek any claim on the University at Albany or anyone else with whom it contracted over the use of my physical likeness and sound recorded by EOC or for any other projects that will grow out of it. This means, among other things, that I will not sue for invasion of privacy, right of publicity, or any other right connected with the use of my physical likeness and sound recorded this day or any other projects that grow out of it. I intend for this to be a blanket release for the University at Albany and anyone else it may deal with in order to broadcast, promote or distribute the images and sound recorded by EOC or any projects that grow out of it.

Yes, I grant the University the right to use my likeness

No, I do not grant to University the right to use my likeness

By signing this application, as denoted by typing my full legal name below, I certify that all of the information is true to the best of my knowledge, including financial and family documentation provided on this form. I authorize the University at Albany Educational Opportunity Centers Program to obtain records relevant to my educational planning process and financial aid eligibility and to release information, as required by law, to the U.S. Department of Education.

Type your full legal name below, to sign this application