LEOC Application

Personal Information

First Name *

Middle Initial *

Last Name *

Preferred Pronouns *

Date of Birth *

Demographic Information

Gender *

Ethnicity *
Hispanic
American Indian/ Alaskan Native
Asian
Black or African American
White
Native Hawaiian or Other Pacific Islander
Multi-Racial

Primary Language *

Citizenship Status *

Did either of your parents receive a 4-year degree from a college/university? *

Are you a veteran? *

Contact Information

Email *

Phone *

Can we contact you via text? *

Address Line 1 *

Address Line 2

City *

State/Province *

State/Province

Zip/Postal Code *

County *

Country *

Education Information

Educational Status *
High School Senior
Currently in GED/ HS completion program
High School Incomplete
High School Graduate
GED Program Graduate
Vocational/ Technical Certificate
Some College
College Graduate

School Attending *

Program Attending

Income Verification

The number of individuals living in my household and/or claimed as dependents (including myself) is... *

Please specify your/your family's taxable income here *

Acknowledgements

Signature *

I certify that all information provided on the application is the truth and correctly noted to the best of my knowledge.

I grant the Laker Educational Opportunity Center (LEOC) Program permission to obtain school records, transcripts, standardized test scores (EOC/EOG/SAT/PSAT/ACT/PLAN) grade reports, test results, and financial aid transcripts from the secondary school and college I am attending until I graduate from college or for 6 years after I graduate from high school, according to the terms of the federal LEOC grant. I will also permit LEOC program staff to speak with teachers, counselors, and other school administrators to obtain and exchange information as part of the services I will receive from the LEOC program. I authorize LEOC to access or release copies of my academic transcripts, test scores, college admissions enrollment, and financial aid information that is necessary to assist in achieving my education goals. ALL INFORMATION RECEIVED WILL BE KEPT CONFIDENTIAL IN COMPLIANCE WITH THE FAMILY EDUCATIONAL RIGHTS AND PRIVACY ACT.

Periodically, students participating in the LEOC program events may be photographed, filmed, or interviewed. I grant permission to the LEOC staff to use my photographs, film or interviews that may be used to promote or publicize the program events or demonstrate how federal funds are utilized to assist students. (Call our office if you have special circumstances and do not want your image used for anything other than your file. We can make exceptions.)

I understand that participation with TRIO LEOC does not guarantee admission to college or receiving financial aid/scholarships.

Laker Educational Opportunity Center

Welcome to the Educational Opportunity Center

Office Location (GR)

Office Location (Muskegon)

Contact Info