Fillable EDUCATIONAL OPPORTUNITY C E NTE R APPLICATION PACKET (Midlands Technical College)

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EDUCATIONAL OPPORTUNITY C E NTE R APPLICATION PACKET (Midlands Technical College)

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  • 1 signature
  • 103 check-boxes
  • 62 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Midlands Technical College

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midlandstech.edu/eoc
i
PO Box
2408
i
C
o
l
u
m
bi
a
, SC
29202
i
8
0
3
.
8
22
.
374
9
MIDLANDS TECHNICAL
COLLEGE
EDUCATIONAL OPPORTUNITY C
E
NTE
R
APPLICATION
PACKET
Legal Last
Name (according to Social Security Card)
First
Name
Middle Initial
Mailing
Address City State Zip
-
-
/
/
Social Security
Number
Date of Birth
Email
Address
Best Contact
Number
Alternate Contact
Number Age
Gender
☐
Male
☐
Female
Race/Ethnicity
☐ Asian,
non-Hispanic/Latino
☐ Am. Indian/Alaska
Native/
non-Hispanic/Latin
☐ Black/African
American/
non-Hispanic/Latin
☐
Hispanic/Latino
☐ Native Hawaiian or
Pacific
Islander/non-Hispanic/L
atino
☐ Race and Ethnicity
Unknown
☐ Two or more
races
non-Hispanic/Latino
☐
White/non-Hispanic/L
atino
Is
English
your
first/
primary
language
?
☐
Yes
☐
No
Citizenship/Military
(check
all that apply)
☐ US
Citizen
☐
Veteran
☐ Active duty of the
military
☐ Spouse of active
military
☐ Child of active
military
☐ Permanent
Resident
(List Alien Registration
#)
A
Dependency Status
If
you can check any of the following
bo
x
es,
you are an
independent
student. If
you
cannot check any of the following
boxes
you are
a dependent
student.
Dependent
students must provide parent
information.
☐ I
am at least 24 years
old
☐ I
am
married
☐ I
have or will have children who
I
will
provide more than half of their support
for
(other than support from parents)
during
the award year (July
1 -
June
30)
☐ I
have dependents
(other than
a spouse
or children) who live with me and
I
will
provide more than half of their
support
during the award year (July
1 -
June
30)
☐ I
am serving on active duty in
the
U.S. Armed Forces for purposes other
than training
☐ I
am
a
veteran of the U.S. Armed
Forces
☐ I
was in foster care or
a
dependent
or
ward of the court since turning age
13
☐ I
am currently or was an
emancipated
minor
☐ I
am currently or
I
was in
a
legal
guardian
-
ship (court-appointed to someone
other
than
parents)
☐ Since
I
turned age
13, both of my
parents
were
deceased
☐ I
am homeless or am at risk of
being
homeless
☐ I
have
a
special circumstance
with
approved documentation
from
Financial
Aid
Marital Status
☐ Never Married ☐ Married ☐
Divorced
☐
Separated
☐
Widowed
Month and year you were married,
separated,
divorced,
or
widowed
/
First Generation Status
Did your father graduate from college
with
a
four-year
degree?
☐
Yes
☐
No
☐
Unknown
Did your mother graduate from college
with
a
four-year
degree?
☐
Yes
☐
No
☐
Unknown
Student Financial Information
Student Taxable Income Level (check
one)
Taxable income
is
not your Adjusted
Gross
Income or earnings for the
year
.
Refer
to
federal
taxes.
☐ Under
$18,735
☐
$45,256 - $51,885
☐
$18
,736 - $25,365
☐
$51,886 - $58,515
☐
$25,366 - $31,995
☐
$58,516 - $65,145
☐
$31,996 - $38,625
☐
$65,146
or
higher
☐
$38,626 - $45,255
☐ Did not file a tax
return
List your total wages, salaries, and tips
for
each respective
year
.
If
no income
was
earned, list
$0
2016
2017
Family Size
(number)
Family size
is
the number of people
for
whom the parent (if
dep endent) or the
student
(if
indep endent) provides more than
50%
of their support for the entire award
year
(July
1 -
June
30)
- Include Yourself.
updated 2-21-19
midlandstech.edu/eoc
i
PO Box
2408
i
C
o
l
u
m
bi
a
, SC
29202
i
8
0
3
.
8
22
.
374
9
EDUC
A
TION
SECTION
High School/GED
I
am currently enrol
led: ☐ High
School ☐ GED/Adult Ed
Have you submitted an admissions application to any
college
,
university
,
or training program
between September
1,
2018
- August
31,
2019?
☐
Yes
☐
No
☐ Currently Taking College
Classes
If
yes, please list the
school(s):
Expected
Completion
Date:
/
(mm/yyyy)
Where
?
Name
of
School/Center
City and
State
☐ I
am
a Hi
gh S
chool Graduate
☐
I
a
m a GE
D
Graduate
/
(mm/yyyy)
Completion Date:
Where
?
Name
of School/Center
City and
State
☐ I
did NOT receive
a
High School diploma or
GED
☐ Highest grade
completed:
College
☐ I
am currently taking classes at the following
school:
Name
of College
City
,
State
Start Term
(mm/yyyy)
☐ Last College
A
ttended:
Name
of College
City
,
State
Start Term (mm/yyyy)
End Term
(mm/yyyy)
Please check if you have earned the following:
☐ College
Diploma
☐ College
Certificate
☐ Associate
Degree
☐ Bachelor’s
Degree
WorkKeys Certificate (select level
below)
☐
Bronze
☐
Silver
☐
Gold
☐
Platinum
Federal
&
T
RIO P
articipation
Check if you are currently
a
participant in any
of
the
federal
programs listed
below:
☐ Talent
Search
☐
WIOA
☐ Student Support
Services
☐
CAREERS
☐ Upward
Bound
Needs Assessments - MUST BE COMPLETED
(check all services needed)
☐ College Admissions Assistance
☐ Financial Aid Assistance (FAFSA)
☐ College Transfer Assistance
☐ Financial Aid Probation/ SAP Appeal Assistance
☐ Student Loan Entrance Counseling/Promissory Note
☐ Scholarship Assistance
☐ Student Loan Default Assistance
☐ Budgeting & Personal Financial Planning
☐ GED Referral
☐ Counseling and Disabilty Referral Services
☐ Major and Career Exploration
☐ Ex-Offender Referral Services
☐ Military & Veteran Referral Services
☐ Homeless & Foster Youth Educational Assistance
☐ Other__________________________________
Please read the following statements an
d check ALL
the boxes signifying that you hav
e read and agree:
☐ I
understand the purpose and services
of EOC
and
meet
the eligibility requirement for the
program.
☐ I
certify that the information provided
on
this
application
is
true and correct to the best
of
my
knowledge
.
☐ I
understand that the information provided
on
this
applica
-
tion will
be
held in strict confidence by the
EOC
staff
.
☐ I
understand that if
I
need accommodations for
disability
to participate in EOC, or in any
of
its scheduled
activities,
I
must contact
EOC
at 803.822.3749 at least
30
working
days prior to the
activity
.
☐ I
have received
a
copy of the FAFSA submi ssion
guidelines
(In EOC Welcome Packet).
Student Signature
Date
Your College Success Plan (CSP) will help you map out the steps to start or continue college and seek the
appropriate resources you need to be successful. Please complete the Education Plan so that we may further
assist you with your educational goals.
midlandstech.edu/eoc
i
PO Box 2408
i
Columbia, SC 29202
i
803.822.3749
MIDLANDS TECHNICAL COLLEGE
EDUCATIONAL OPPORTUNITY CENTER
COLLEGE SUCCESS PLAN
List the college you are currently attending or plan to attend in the upcoming school year.
List when you first started attending or plan to start attending this college (Start Term or MM/YYYY).
List all majors or careers of interest.
List the college(s) you are interested in for transfer.
List when you plan to transfer (Start Term or MM/YYYY)
EDUCATION PLAN- MUST BE COMPLETED
What or who is your motivation to go to college?
FERPA and Release of Information
The Family Educational Rights and Privacy Act (FERPA) of 1974 is a Federal law designed to protect the privacy of a student’s education
records. The law applies to all schools which receive funds under an applicable program of the U.S. Department of Education. Under
FERPA, disclosure of information from a student’s educational record is strictly limited and you must have a FERPA Release Form on file with
the EOC Office before any EOC staff member can discuss your student account over the phone or in person. If you or an authorized party
visits the office in person, you or the party must show photo identification, driver’s license, and/or student ID card to discuss your
educational records. The party’s name must also appear on the FERPA Release Form. All of your records will be kept in confidence and in
accordance with the Family Educational Rights and Privacy Act (FEPRA) of 1974.
Student Signature
Date
I hereby grant permission for the Educational Opportunity Center to transmit and/or request any information about me for the
purpose of verifying income information, making educational decisions, and for facilitating the successful completion of my
educational plans. I further authorize the colleges/schools I attend to release this information to MTC EOC for federal outcomes
tracking and reporting purposes. Such records may include but not limited to: test scores, class schedules, transcripts, college
admission information, financial aid, and enrollment and graduation verification. This information may be obtained from high
schools, colleges, universities, and other agencies.
Provide full name and address of (individual (s) to whom access to records may be provided: (Optional)
Legal Last Name
First Name
Middle Initial
Last 4 of SSN
Name
Name
Relationship
Relationship
XXX -XX-
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Completed 4 October 2020

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