EOC Intake Form Boston 2024-2025

All information is kept confidential. 

Dear Applicant,

By completing this form, you are expressing interest in joining our TRIO EOC program, a free program that will provide you with the necessary support and tools to pursue higher education and career.

To receive services, this form must be completed and signed. A parent/ guardian signature is required if you are not a veteran, not married, do not have a dependent or are under the age of 24.

Contact Information
Name
Address
Contact by Text
Demographics
Gender Identity
Ethnicity
Is English your first language?
Marital Status
Are you a U.S. Citizen?
A

Did your parents graduate from a U.S. 4-year college?

Parent 1
Parent 2
Do you have a Career Goal?
How many people are in your immediate family living with you? (Include yourself and all family members dependent on the income level selected above.)
Military

Check all that apply
Financial Information
Taxable Income Level

Select the range of your family’s Taxable income for LAST YEAR
PRIMARY Income Source
Signatures

I certify that this information is correct and understand that, by signing this form, I give permission to the Educational Opportunity Center to access my, or my son’s/daughter’s educational past and future enrollment information regarding schools/programs I/he/she has attended in order to track my, or my son’s/daughter’s educational progress. I authorize MassEdCO to contact me regarding MassEdCO’s EOC Program at the phone numbers that I or my son/daughter provide on this form or any future number that I provide for a cell phone or other wireless devices using automated telephone dialing equipment or artificial or prerecorded voice or text messages. I also consent to periodic emails to be sent to me or my son/daughter through email to any addresses that I or my son/daughter provide to MassEdCO.

Sign above
Sign above