EOC is able to provide FREE services through funding from the U

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.

First Name:

Last Name:

Address:

City:

State:

Zip:

E-mail:

Date of Birth:

Are you a US citizen? Yes       No

Last grade level completed:

Family Size:

TAXABLE Income Levels:

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.

First Name:
Last Name:
Address:
City:
State:
Zip:
E-mail:
Date of Birth:
Are you a US citizen?	Yes No
Last grade level completed:
Family Size:
TAXABLE Income Levels:
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