Fillable SUPPLEMENTAL FORM 2020-2021 (SUNY Brooklyn Educational Opportunity Center)

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SUPPLEMENTAL FORM 2020-2021 (SUNY Brooklyn Educational Opportunity Center)

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SUPPLEMENTAL FORM 2020-2021
EDUCATION INFORMATION
Have you earned a high school diploma? (U.S. or foreign) ? Yes No
Name of high school attended:
Have you earned a GED or TASC certificate Yes No
If you do not have a high school diploma, GED, or TASC certificate, what is the highest grade level completed? ____
College Prep Applicants ONLY: Have you taken the CUNY Placement Test? Yes No
If you attended college, please list out the college(s) attended and additional information below. Applicants
may be asked to submit unofficial college transcripts
College Attended
Credits Earned
Degree Earned
Major
☐ Yes ☐ No
☐ Yes ☐ No
APPLICANT INFORMATION
LAST NAME:
EMAIL:
GENDER: Male Female
ADDRESS - with Apt. # included:
INCOME INFORMATION
Yes No
Full-time
Part-time
$
Yes No
CITIZENSHIP/RESIDENCY INFORMATION
Have you lived in NY State for at least 1 year or more? Yes No
Citizenship Status (check one) U.S. Citizen Permanent Resident Refugee Visa
Choose a program
:
SUPPLEMENTAL FORM 2020-2021
HOW WERE YOU REFERRED TO THE BEOC? - Select ALL that apply
Bedford Stuyvesant Restoration Plaza
Department of Labor
HRA
BEOC Student
Employer
Internet/online search
Brooklyn Public Library
Other EOC
NYCHA
CAMBA
Family Member
Walk-in
Career and College Fair
FEDCAP, Inc.
Workforce 1
Church/Religious Organization
Friend
City Tech (CUNY)
High School
Counselor
Other
Other CUNY
ADMISSIONS APPLICATION MATERIALS:
NOTE: Admissions files will be reviewed after applicants complete an online application, a
supplemental application (this form) and submit copies of required documents.
Documents and application materials submitted to BEOC
become the property of BEOC. They cannot be returned.
Emergency Contact: Person we should contact in case of emergency.
Contact’s Name:
Contact’s Telephone:
Contact’s Email address:
Relationship to you?
The information contained in my on-line application and supplemental application is
true and accurate to the best of my knowledge. False and misrepresented information
may result in my application and/or registration being revoked.
Applicant Signature: ____________________________________ Today’s Date:
Please specify:
SUNY For All Website
Please specify:
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SUPPLEMENTAL FORM 2020-2021 (SUNY Brooklyn Educational Opportunity Center)

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Completed 14 June 2021

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