Thank you for your interest in Jackson State University's Educational Opportunity Center! 

The EOC at Jackson State University is a TRiO program dedicated to assisting individuals and families as they navigate the admissions and financial aid processes to gain college/university or vocational/ technical school enrollment. we deliver literacy to increase awareness of postsecondary education opportunities available for central Mississippi's low-income, first-generation, and/or educational disadvantaged adult population who desire to pursue a postsecondary education. With intention, we work to fulfill the mission for the benefit of the students in Copiah, Hinds, Holmes, Scott, Simpson, Warren, and Yazoo counties.

Demographic Information:
Social Security Number *
Last Name *
First Name *
Middle Name
Permanent Address *
City
State
Zip
County of Residence *
Cell Phone *
Email *
Date of Birth *
Age *
Ethnicity
Citizenship
Alien Registration Number
Are you a veteran of the U.S. Military

Educational Information
Did you graduate High School?
Are you currently in high school?
What grade are you in?
High School Name:
If you are currently in high school, skip the next 3 questions.
What is the highest grade you completed in high school
What is the last year you attended high school?
Name of High School?
If you graduated from high school skip the next 4 questions.
Have you Earned a GED or high school equivalent?
State Recieved
Test Site
Are you currently enrolled in an ABE/GED program? (Check if yes)
Are you currently enrolled in a postsecondary institution, including junior college, university, or technical school?
Have you ever attended college?
Did you graduate?
Do you have existing student loans?
if you have ever participated in any federal TRIO program, please select all that apply.
Are you currently being served by another TRIO program?
If yes, which program
Did either of your parents, foster or adoptive, complete a bachelor (4 year) degree?

Income Information
Do you currently have a FAFSA on file?
Dependency Status

A financially independent participant is at least 24 years old as of January; married; a veteran of the US Armed Forces; and/or an orphan or ward of the court until age 18. Independent participants must complete the following question

A financially dependent participant is required to have a parent/legal guardian(s) to complete and sign the financial information in the following question.
Income Bracket *
Household Size
By completing this form, which will serve as a statement of income, you are certifying that the information submitted regarding the family size and taxable income is true to the best of you knowledge
Income Certification
Signature Type: Simple    Start Over
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Signature: (Type in your full name)
I agree to the terms included.

Services Needed
If your family needs specific information about other economic programs in your community, briefly describe your needs. Please be as specific as possible. For example, you may be a new mother who needs help buying formula or would like parenting skills classes. The information contained in this application is confidential and will not be released without your permission.
How did you hear about the Educational Opportunity Center?
Program Name
Agency Name
Other

Certification of Application and Information Release

I/We certify that the information provided on the application is true and correct to the best of my/our knowledge; I/We further understand that the completion of this application does not guarantee acceptance into the Educational Opportunity Center (EOC) program.

I/We authorize the use of my image and name in EOC publications , editorials, advertisements, and media releases to the EOC program and its affiliated organizations.

I/We understand that if I need accommodation for a disability to participate in the EOC, or any of its scheduled activities, I/We must contact the Director of the Educational Opportunity Center at 601.979.3335 at least 3 working days prior to the activity.

I/We will make every effort to provide the EOC with any requested documentation needed to evaluate/ track/ report academic progress.

Student information is confidential and protected by the Family Educational Rights & Privacy Act (FERPA). We cannot release or obtain certain information without you written permission. I/We authorize EOC to request, receive, and release any academic and financial secondary and/or postsecondary information to assist with services needed.

I/We further authorize EOC to communicate verbally out otherwise with campus staff and faculty and/or off campus professionals on my behalf to assist with services needed.

My/Our consent will remain in effect until I/We revoke this authorization, in writing, with the EOC office.
Participant Name *
Signature *
Signature Type: Simple    Start Over
Click here to start signing.
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Signature: (Type in your full name)
I agree to the terms included.
Date
If under 18, a parent(s)/guardian(s) signature is also required.
Parent/Guardian Name
Signature
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.
If your parent is not present, but you have recieved verbal confirmation of their consent to participate in JSU's EOC, check here.