Educational Opportunity Centers
Palm Beach State College
4200 Congress Avenue, MS #28
Lake Worth, FL 33461-4796
Phone: (561) 868 – 3681 Fax: (561) 868 – 3394
The EOC Program is a federally funded program designed to assist adults 19 and older in achieving their educational goals
through GED referrals, college application assistance, financial aid assistance and career planning.
Applicant Information
Name: Last
First
Middle Initial
Date of Birth:
Address:
Phone Number:
City:
State/Zip:
Social Security Number:
Student ID Number:
Email Address:
Gender:
□ Yes
Are you/have you ever been a ward of the state?
Citizenship: □ U.S. Citizen
□ Permanent Resident
Alien Registration #:
Ethnicity:
□ American Indian or
Alaska Native
□ Asian
□ Black or African
American
□ Native Hawaiian or Other
Pacific Islander
□ Hispanic/Latino
□ White
□ Other:______________
□ No
□ Male
□ Female
Are you a veteran of the U.S. Armed
Forces?
□ Other classification
□ Yes
□ No
Issue Date:
How many people live in your household? ______
Approximate family income:
□ $0 - $16,755
□ $22,696 - $28,635
□ $34,576 - $40,515
□ $16,756 - $22,695
□ $28,636 - $34,575
□ $40,516 - $46,445
□ $46,446 - above
What service(s) do you need:
□ Admission Assistance □ GED Prep
□ Financial Aid
□ Academic Advising
□ Other: _______________________________________________________________
Education
Does your mother have a bachelor’s degree?
□ Yes
□ No
Does your father have a bachelor’s degree?
□ Yes
□ No
Check your current educational status:
□ High School Student - If so, what school and grade? _______________________________________________
□ Post-Secondary Graduate
□ Post-Secondary Stop-Out
□ High School Stop-Out
□ Enrolled in GED Program
□ High School/GED Graduate
□ College Student – What school? _______________________
Disclaimer and Signature
I certify that my answers are true and complete to the best of my knowledge.
I agree to furnish the Educational Opportunity Centers a copy of my latest income tax return or other official documents to verify the above
information upon request.
Signature:
Date:
Revised 10/30/12
Office Use Only: □ Walk-In □ PBSC – Gardens □ PBSC – Boca □ PBSC – Belle Glade □ Outreach____________________
IMPORTANT FINANCIAL INFORMATION FROM THE EDUCATIONAL OPPORTUNITY CENTERS
The staff of the Educational Opportunity Centers is here to assist you in completing your Financial Aid Form. Please
understand that we are not part of any Financial Aid Office. You must adhere to policies and procedures as set forth by
the federal government and the postsecondary educational institution to which you will attend.
We encourage you to attend an official Financial Aid Workshop offered by the Financial Aid Office of the school you
plan to attend. We also encourage you to see a Financial Aid Representative located at your educational institution.
Please complete and sign the form below to confirm your understanding of the financial aid process and to authorize
access to financial aid and/or educational information.
RELEASE AND AUTHORIZATION FORM
I hereby authorize and request the release to the Palm Beach State College Educational Opportunity
Centers any and all information requested pertaining to my academic and activity records as well as
any of my financial aid records.
I understand that this information will be used for the purpose of determining my eligibility for the
program and the services required to best meet my needs as a student. I also understand that this
information will be maintained in a confidential file in a locked cabinet within the EOC Office.
I further understand that the Educational Opportunity Centers is not a college Financial Aid Office and
that I must comply with all financial aid instructions provided by my institution.
I have read the above information. I understand it and agree to abide by it.
Last Name
First
________________________________
Social Security Number
Middle
(Maiden)
________________________________
Date of Birth
________________________________
Student Signature
________________________________
EOC Advisor Signature
________________________________
Date
_______________________________
Date
Educational Opportunity Centers
Palm Beach State College
4200 Congress Avenue, MS #28
Lake Worth, FL 33461-4796
Phone: (561) 868 – 3681 Fax: (561) 868 – 3394
Financial Literacy/FAFSA Pre-Test
1. What does FAFSA stand for?
6. How do you apply for a Pell Grant?
a. Free Application for Federal
Student Aid
b. Free Application For Student
Aid
c. Free Aid For Students AllAround
a. Over the telephone or in person
at the financial aid office at your
local college.
b. You automatically apply by
completing the FAFSA.
c. By completing a college
application.
2. What are the benefits of budgeting?
7. Besides Pell Grants, what other types of
need-based aid can you apply for?
a. Helps us become fiscally
responsible.
b. It allows you to save more
money.
c. Gives you a plan for
weekly/monthly/annual
spending.
d. All of the above.
a.
b.
c.
d.
8. What are examples of good debt?
3. Do you have to reapply for financial aid
every year?
a.
b.
c.
d.
e.
a. Yes
b. No
4. You need to be admitted into a program
before you apply for financial aid.
a. True
b. False
Mortgage loans
Student loans
Multiple credit cards
Both A & B
All of the above
9. Which type of financial aid has to be
paid back?
a. Loans
b. Scholarships
c. Grants
5. Justin just found a job with a take-home
pay of $2,000 per month. He must pay
$800 for rent and $200 for groceries
each month. He also spends $200 per
month on transportation. If he budgets
$100 each month for clothing, $150 for
restaurants and $250 for everything
else, how long will it take him to
accumulate savings of $900?
a.
b.
c.
d.
Work Study
Loans
Other Grants
All of the above
One month
Two months
Three months
Four months
Revised 10/30/12
10. If you went to college and earned a four
year degree, how much more money
could you expect to earn over a person
with only a high school diploma in your
lifetime?
a.
b.
c.
d.
A little more; about 20% more.
A lot more; about 80% more.
About 10 times as much.
About the same.
Results: ___ /100
INDIVIDUAL EDUCATION PLAN (IEP)
Palm Beach State College
Educational Opportunity Centers
CHECK THE LEVEL OF EDUCATION YOU WISH TO ACHIEVE:
_______
_______
_______
_______
_______
A.
B.
C.
D.
E.
Completion of high school _____ or GED _____
Vocational/Technical Program
A two-year community college (Associate degree)
A four year college or university (Bachelor’s degree)
Graduate degree (Master’s, Specialist, Doctorate degree)
PLEASE CHECK THE AREA(S) BELOW IN WHICH YOU NEED ADDITIONAL INFORMATION AND/OR
ASSISTANCE.
ACADEMIC SUPPORT/CAREER PLANNING
FINANCIAL AID INFORMATION
_____ Assistance selecting a career based on my
interests (Career Counseling).
_____ FAFSA assistance (financial aid application).
_____ Financial literacy information.
_____ Assistance establishing short/long term
goals.
_____ Information on enrolling in a post-secondary
education program.
_____ Grant, loan, or scholarship Information.
_____ Loan verification assistance.
_____ Loan default counseling.
_____ Assistance selecting courses for term or
semester.
_____ Enrollment assistance.
HIGH SCHOOL/GED INFORMATION
ADMISSIONS ASSISTANCE
_____ ACT, TABE, PERT, FCAT, or other testing
information .
_____ Post-secondary application assistance.
_____ Information on post-secondary education
opportunities in Palm Beach County.
_____ Information on how to obtain a high school
diploma.
_____ GED/TABE testing information.
_____ Information on college credit transfers.
_____ TABE test information.
_____ Information on post-secondary admissions.
___________________________________________
Student’s Signature
____________________
Date
___________________________________________
Advisor’s Signature
____________________
Date