EOC Logo

      Please submit this intake form so the RI Educational Opportunity Center can help you achieve your goals!

      Complete this application as thoroughly as possible. This form will take a few minutes to complete. Please note that you will not be able to save a partially completed application. If you are unable to complete the form, you will need to re-enter your information.

       You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.

      If you have any questions, contact the Coordinator / Counselor who is assisting you or call 401-455-6028.

      Personal Information
      Today's Date *
      First Name *
      Middle Initial
      Last Name *
      Preferred Name
      Coordinator / Counselor *
      (Choose the EOC counselor who is helping you.)
      What is your Date of Birth? *
      Your Age *
      Street Address *
      City *
      State *
      Zip Code *
      Cell Phone Number *
      Other Phone Number
      Email Address *
      Gender *
      What is your Marital Status?
      What is your Citizenship Status? *
      What is your Race & Ethnicity? *
      What is your primary language? *
      Are you proficient in English? *
      What state or country were you born in? *
      Are you, your spouse, or parent on active military duty?

      (If not, please leave the box empty.)

      Eligibility

       These questions help us determine if we can provide services for you:
      Were you raised by parent(s) who earned a 4-year college degree before you turned 18? *
      What is your family size? *
      (the number of people in your household, including yourself)
      What was your taxable household income last year? *
      (See your tax return: It's line 15 on your 2022 or 2023 return)
      What is your primary source of income? *

      Education

      Answer the following questions about your previous education.

      If any don't apply to you, please leave them blank.
      Do you have a high school diploma or GED certificate? *
      If you have a high school diploma, which high school did you graduate from?
      If you have a GED certificate, where did you receive it?
      Are you currently enrolled in high school or a GED program? *
      If you are currently enrolled in high school, where are you enrolled?
      If you are currently in a GED program, where are you enrolled?
      Have you taken college courses? *
      If so, where did you attend?
      Have you completed a college program? *

      Other Questions

      You're almost done!

       
      How did you hear about the RI Educational Opportunity Center (EOC)? (friend, CCRI, Counselor, etc)? *

      How can the RI Educational Opportunity Center help you?

        (check all that apply)
      Academic Advising
      Career Counseling
      College Admissions Application
      College Info / Transfer Information
      Defaulted Student Loan Info
      ESL Information
      Financial Aid Application (FAFSA, Verification)
      Financial Literacy Info
      FSA ID Assistance
      GED Information / Enroll in GED Program
      Other Financial Aid Assistance
      Scholarship Information / Applications
      Training Programs Info
      Other Ways we can Help
      Do you know your FSA (Federal Student Aid) user name and password? *
      CCRI ID Number
      (If you don't have one, please leave this question blank)

       

      I certify that the information provided is accurate. I understand that it may be used for statistical and tracking purposes. I authorize RIEOC to maintain a file relevant to my educational planning, enrollment, attendance and financial aid status. 

      RIEOC has further permission to collect additional information to provide further services. I hereby authorize any agency or educational institution to release my academic/financial aid or other pertinent information as requested by RIEOC.

      (Sign the pad, type in your full name, check "I agree" then click on "Sign and Submit Signature")
      Your 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's information is required for your FAFSA application, have them sign below.

      (If not, skip this and click submit application at the bottom of the page)
      Parent 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.