SUNY Syracuse EOC Online Interest Form

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Disclaimer: This is the first step of the application process, and no admissions decision will be made by completing this form.

First Name *

Please type your last name as it appears on your identification.

Middle Name

Please type your middle name as it appears on your identification. If you do not have a middle name, please leave this blank.

Last Name *

Please type your last name as it appears on your identification.

Date of Birth (MM/DD/YYYY) *

Please input your birth date as it appears on your identification or birth certificate. For example: 06/01/1977

Email *

Were you referred to us through SUNY for All? *

Yes

No (please let us know how you heard about us by answering the next question)

If No, how did you hear about the SUNY Syracuse EOC? (please check all that apply)

Newspaper

Radio

Friends

Family

Direct Mail

Agency Referral

Employer

Billboard

Bus

Bus Shelters

FaceBook

Instagram

Other:

Have you been a New York State resident for at least 1 year or are you a recently arrived legal refugee? *

Yes

Home Address (Street Number and Street Name) *

Home Address (City) *

Home Address (State) *

Home Address (Zip Code) *

Phone number

Have you been a Syracuse EOC Student before? *

Yes

Required

If Yes to above, when approximately and in what program?

Emergency Contact Name

Emergency Contact Phone Number

Emergency Contact Relationship

Mother

Father

Spouse

Sibling

Aunt

Uncle

Grandparent

Friend

Other:

Clear selection

When are you interested in enrolling? *

Next Available

Fall (Begins September)

Spring (Begins January)

Unsure

Required

Which class are you interested in taking? *

Tech Center

OSHA 10 HR Construction Safety Certification (no High School Diploma or equivalent required) (2 day class)

OSHA 30 HR Construction Supervisor Certification (must have OSHA-10 card and be currently employed in construction) (5 day class)

Build Ready Construction (no High School Diploma or equivalent required) (4 week program)

Department of Transportation Work Smart Construction Training Program- (High School Diploma or equivalent required) (7 week program)

English for Speakers of Other Languages (ESOL) to build your English language skills (15 week program)

High School Equivalency to prepare for the TASC formerly GED test (15 week program)

Introduction to Health Careers (no High School Diploma or equivalent required) (2 week program)

College Preparation (High School Diploma or equivalent required) (15 week program)

Computer Software Training (no High School Diploma or equivalent required) (15 week program)

Medical Billing & Coding (High School Diploma or equivalent required) (15 week program)

Medical Secretary (High School Diploma or equivalent required) (15 week program)

New York State Certified Nursing Assistant (High School Diploma or equivalent required) (10 week program)

New York State Certified Nursing Assistant Recertification (no High School Diploma or equivalent required, prior NYS C.N.A. certification required) (3 weeks)

New York State Security Guard Certification (High School Diploma or equivalent required) (1 day class)

New York State Security Guard Annual Recertification (no High School Diploma or equivalent required, prior NYS Security Guard certification required) (1 day class)

SURGE Advanced Manufacturing (High School Diploma or equivalent required) (3 week program)

SURGE Digital Customer Service (High School Diploma or equivalent required) (5 week program)

Telecommunications & Cabling (High School Diploma or equivalent required) (7 week program)

Demographic & Education Information

Some of the information in the section is optional. Your responses provide EOC with information regarding how best to serve you to fulfill your educational and vocational needs and to help determine your eligibility to take classes at SUNY Syracuse EOC.

Gender

Male

Female

Prefer not to answer

Other:

Race

Asian

Black or African American

American Indian or Alaskan Native

Native Hawaiian or Pacific Islander

White

Prefer not to answer

Other:

Ethnicity

Hispanic or Latino

Not Hispanic or Latino

Prefer not to answer

Other:

Do you have a

High School Diploma

GED/TASC Diploma

IEP Diploma

Other:

Highest Grade Completed

Are you a day or evening student?

Day

Evening

Unsure

Are you a veteran?

Yes

Are you an ex-offender (convicted of a felony)?

Yes

Are you a single parent?

Yes

Are you a displaced homemaker? (A displaced homemaker is generally a person who previously provided unpaid services to the family. For example, were you a stay-at-home mom or dad? Are you no longer supported by your spouse? Are you underemployed or unemployed? Are you having trouble finding or upgrading employment?)

Yes

Are you a registered voter?

Yes

Are you a limited English speaker?

Yes

What is your primary language?

Please check any box(es) below if you wish to identify your specific limitations/conditions (All information is kept strictly confidential):

Hearing Impaired

Learning Disabled

Mobility Impaired

Psychologically Impaired

Multiple Disabilities

Visually Impaired

Other Impairments

Employment & Income Information

The following information is required of all applicants. ALL classes at SUNY Syracuse EOC are free. Therefore, all students must be income qualified to participate.

Please estimate last year's total combined household income from all sources. Add a zero if you had no income last year. (Examples: Work, Public Assistance, Unemployment, Disability/Workman's Compensation, Social Security, etc.) Please only USE NUMBERS (123456). *

How many total individuals live in your household and are supported by your familiy income? *

Are you currently employed? *

Yes

Required

If yes:

Full Time

Part Time

Are you Head of Household? (A head of household is an individual in a family setting who provides support and maintenance to one or more individuals who are related to him or her through adoption, blood, or marriage) *

Yes

Required

Are you Single Head of Household? *

Yes

Required

Are you presently receiving income from any of the sources listed below? (please check all that apply) *

Wages

DSS Safety Net

DSS TANF

Food Stamps

Unemployment

Social Security- Retirement Benefits

Social Security- SSD

Social Security- SSI

Child Support

Worker's Compensation

I do not receive income from any of these sources

Required

Are you completely vaccinated for COVID-19? *

Yes (complete vaccination is two weeks after your last shot for the two-shot series for Moderna and Pfizer or two weeks after your Johnson & Johnson shot)

Required

Have you received your COVID-19 Booster? *

Yes

No (it has been less than 6 months since my last dose of the vaccine)

Required

Are you able to provide proof of vaccination for the COVID-19 vaccine if required? *

Yes

Required

Thank you for taking the time to complete the SUNY Syracuse EOC Interest Form! We look forward to assisting you in fulfilling your educational & professional goals.

By submitting this form you acknowledge that you are beginning the application process but that no eligibility decision is being made based purely on the information you provide here.

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