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Thank you for your interest in our EOC program! The EOC serves individuals in Allegan, Berrien, and Cass County in Michigan and LaPorte and St. Joseph County in Indiana. Please complete this application as thoroughly as possible. You cannot save and restart this application. You may want to review items on this application before submission. If you have any questions, please call our office at (269) 927-8869 and leave a message.

General Information 
First Name *
Middle Name
Last Name *
Date of Birth *
Gender *
Ethnicity *
Address *
City *
State *
Zip Code *
County *
Marital Status *
Citizenship *
Home Phone *
Is this a cell phone?
Please select yes or no:
Email *

Additional Information:
Current Grade Level *
Current Age *
Military Connected

Eligibility - Family/Income Information:
Parents Education Level
How many people in your household? *
Household Income Range *

Educational Assistance Needed: (check all that apply)

GED Information
Tutoring GED/College Assessment
Financial Aid/FAFSA
Financial Aid Appeals
Scholarships/Other Aid Options
College Applications
College Exploration
Career Options/Assessment/Informtion
Transcript Request
Academic Advising
Veteran Services
Other:

Educational Goal:
Earn GED/HSD
Earn Vo-Tech Certificate
Earn Associates/Bachelor's Degree
Other:

Career Interest:

Example: Business/HVAC/CAD/Nursing/Sonography

Description

Are you CURRENTLY participating in a TRIO Program?

If yes, please check all that apply.

Upward Bound
Upward Bound Math/Science
Veterans Upward Bound
Talent Search
GEAR UP
Student Support Services
If Yes, when and where?

STATEMENT OF RELEASE OF INFORMATION AND CONFIDENTIALITY

I understand that providing my Social Security Number allows the EOC to track my educational progress.  

Social Security Number *
Signature:

I hereby consent the release of my post-secondary information to the EOC program at Lake Michigan College, effective for the period of time that I am an active EOC participant and receive EOC services.

** I affirm that my reported income does or does not exceed the levels listed in the Eligibility/Income section of the application.

I understand that the Educational Opportunity Center is a federally-funded program, this application is subject to review by Federal authorities, and I will be held responsible for the certifications made by my signature.

I affirm all information provided on this application is true and accurate to the best of my knowledge.

Sign Here *
Please select a signature verification type.