TRIO EOC 2020-21 Outreach Intake Form
The TRIO EOC is funded by the Department of Education with the goal of serving 1,000 participants to attend any 2-year or 4-year college/university. Please complete this confidential form to authorize the TRIO EOC program to serve you with any of the following in person or virtual college access services: FAFSA and Admission Application Completion, Financial Aid Follow-up, College Information, Scholarship Search, Student Loans, Transfer Assistance, Academic & Career Counseling, GED Information, or a Defaulted Student Loan. We serve the residents of Franklin, Halifax, Henry, Patrick, and Pittsylvania Counties and the cities of Danville and Martinsville.


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Email *
What is your first name? *
What is your last name? *
Date of Birth *
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DD
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Street Address *
City *
State *
Zip Code *
Phone Number *
Are you Hispanic or Latino? *
Race *
Citizenship Status *
Are you "Military-Connected"  as a   *
Marital Status *
Gender, assigned at birth *
Age *
How many are in your household / How many are your dependents? Example 4/0 *
Does your Mother have a (4-year) bachelor’s degree?   *
Does your Father have a (4-year) bachelor’s degree? *
Taxable Income from  IRS Form 1040, line 10 *
Additional Sources of Income: *
Required
Are you Employed? *
My intent is to enroll in: *
Program of study I intend to enroll in: *
I need assistance with (Check all that apply): *
Required
Your Educational Status as of Today: *
Are you currently participating in a high school Talent Search Program? *
How did you hear about our Educational Opportunity Center? *
FAFSA Fever Workshop
Detailed information about completing the 2021-22 Federal Application for Student Aid (FAFSA). Please select if you are interested in the Workshops and submit. The Workshop link will be emailed 24 hours prior to the event.
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