Thank you for your interest in our EOC 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 We Do & It's Free!
____________________________________________________________________________________________________________________________________
First Name *
Last Name *
Perm Address *
Perm Address 2
Perm City *
Perm State *
Perm Zip *
County
Citizenship *
Cell Phone *
By checking this box-I am opting out of receiving Cell Phone Texts
English LP
I am interested in:
____________________________________________________________________________________________________________________________________
Email
Marital Status *
Date of Birth *
Age *
Do you have a Disability?
Were you ever in Foster Care?
Gender *
Ethnicity *
Military Connected
Did either of your Parents receive a Bachelor Degree from an Accredited University/College? *
Household Size *
Household Taxable Income *
Household Income is:
Does anyone in the household receive: SNAP, SSI, SSD, WIC, Free School lunch, MA? Please list:
Current Grade Level *
Have you Completed a Degree?
Services Requested: *
Other Federal Program
Referred By
So We can provide you the best service-Tell Us About Yourself!
____________________________________________________________________________________________________________________________________
Signature *
Please select a signature verification type.
Parent Signature for Dependent Students
Please select a signature verification type.