EOC is able to provide FREE services through funding from the U.S. Department of Education. We are required to obtain the following information to merit funding. This information is kept STRICTLY CONFIDENTIAL.

To sign up for FREE services and be able to log into the Members' Area, complete the form below. Be sure to enter a valid e-mail address, as your password will be mailed to that address. If you have any questions regarding the information you are asked to provide, please read our Privacy Statement.

ALL fields are required:

First Name:
Last Name:
Address:
City:
State:
Zip:
E-mail:
Date of Birth:
Are you a US citizen?	Yes       No
Last grade level completed:	Please Select 7 or less 8 9 10 11 High School Graduate GED Post High School 1 year Post High School 2 years Post High School 3 years Professional Certificate/License Associate's Degree Bachelor's Degree Master's Degree Doctorate's Degree
Family Size:	Please Select 1   2   3   4   5   6   7   Greater than 7
TAXABLE Income Levels:	Please Select 0 - 14,355 14,356 -19,245 19,246 -24,135 24,136 -29,025 29,026 -33,915 33,916 -38,805 38,806 -43,695 43,696 -48,585 48,586 and up
Did your mother or father receive a four-year college degree before you were 18 years old?	Yes       No
Are you a Talent Search / S.P.A.R.C. student?	Yes       No

I certify that the above information is correct.  I give permission for EOC, Inc. to verify my enrollment in school, and to use this information to assist in my career and educational planning or in EOC, Inc. project reports that do not identify me by name.  This is confidential information requested for statistical reports only.