SUNY Syracuse EOC Online Interest Form
Disclaimer: This is not an official application and you will not be denied admissions to SUNY Syracuse EOC based on your answers.
* Required
First Name
*
Please type your first name as it appears on your identification.
Your answer
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.
Your answer
Last Name
*
Please type your last name as it appears on your identification.
Your answer
Date of Birth
*
Please input your birth date as it appears on your identification or birth certificate.
MM
/
DD
/
YYYY
Email
*
Your answer
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
TV
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
No
Home Address (Street Number and Street Name)
*
Your answer
Home Address (City)
*
Your answer
Home Address (State)
*
Your answer
Home Address (Zip Code)
*
Your answer
Phone number
Your answer
Have you been a Syracuse EOC Student before?
*
No
Yes
Required
If Yes to above, when approximately and in what program?
Your answer
Emergency Contact Name
Your answer
Emergency Contact Phone Number
Your answer
Emergency Contact Relationship
Mother
Father
Spouse
Sibling
Aunt
Uncle
Grandparent
Friend
Other:
Clear selection
When are you interested in enrolling?
*
Next Available
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)
High School Equivalency to prepare for the TASC formerly GED test (15 week program)
English for Speakers of Other Languages (ESOL) to build your English language skills (15 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)
Telecommunications & Cabling (High School Diploma or equivalent required) (7 week program)
Build Ready Construction (no High School Diploma or equivalent required) (4 week program)
Customer Service Ready Call Center Training (no High School Diploma or equivalent required) (3 week program)
ProTrain Manufacturing (no High School Diploma or equivalent required) (6 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
Your answer
Are you a day or evening student?
Day
Evening
Unsure
Are you a veteran?
Yes
No
Are you an ex-offender (convicted of a felony)?
Yes
No
Are you a single parent?
Yes
No
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
No
Are you a registered voter?
Yes
No
Are you a limited English speaker?
Yes
No
What is your primary language?
Your answer
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).
*
Your answer
How many total individuals live in your household and are supported by your familiy income?
*
Your answer
Are you currently employed?
*
Yes
No
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
No
Required
Are you Single Head of Household?
*
Yes
No
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
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. A SUNY Syracuse EOC Counselor will contact you very soon.
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