EOC Program 24.25

Thank you for your Interest in our Amazing Program!

Please complete this application as thoroughly as possible. Educational Opportunity Centers of PA is committed to helping you achieve your educational goals!

If you have any questions, please call our office at (570) 331-6755

Yes, EOC Does & It is FREE!

Last Name *

First Name *

Perm Address *

Perm City *

Perm Zip *

County *

Citizenship *

Cell Phone *

Cell Phone Opt Out

English LP

I am Interested in: *

Veteran

Email *

Marital Status *

Date of Birth *

Age First Service *

Disability?

Were you ever in Fostercare?

Gender *

Ethnicity *

Military Connected

Did either of your Parents receive a 4-Year College Bachelor Degree? *

Household Size *

Income Bracket *

My Household Income is: *

Does anyone in the Household Receive any of the following? SNAP, MA, TANF, SSI, SSD, WIC

Current Grade Level *

Have you Completed a Diploma or Degree? *

Services Requested from EOC: *

Other Federal Program

Referred by:

I assure that the information provided in this application is accurate. My signature indicates my intent to join the EOC program of Educational Opportunity Centers of PA.

Signature *

Please select a signature verification type.

Parent/Guardian Signature for Dependent Students:

Please select a signature verification type.