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EDUCATIONAL OPPORTUNITY CENTERS (EOC) PROGRAM

Application for Program Services

Allow 5-7 days for processing. 

  • You must be age 19 or over to participate in the EOC program.

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General Information:
Last Name *
First Name *
Middle Initial
Gender *
Address *
Apartment #
City *
State *
Zip *
County *
Cell Phone *
Email *
Date of Birth *
Age First Service *
Ethnicity
Social Security Number
Citizenship
Permanent Resident Number (if you are not a citizen)
Parent(s) Completed College
Military Connected
Veteran
Academic Need *
Special Assistance Request
Household Size *
Income *
Current Labor Status *
Current Grade Level *
Major or Career Desired
Where did you hear about us?
Entry Date (today's date)
I want to Participate in the TRIO/EOC Program

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Certification and Signatures:

To the best of my Knowledge, the information that I provided is true, complete and accurate. I understand that the EOC Program may need to discuss on my behalf with agencies and/or education institutions such information to assist in completing goals, enrollment and financial aid assistance needs.

Sign here *
Please select a signature verification type.

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Media Authorization:

I, the under signed, authorize the TRIO Educational Opportunity Centers Program at Wichita State University to use photographs and/or videotape bearing my image for the EOC program newsletter and program communications highlighting adult learner student success
Sign here
Please select a signature verification type.