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.
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
Have you been a New York State resident for at least 1 year or are you a recently arrived legal refugee? *
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? *
Required
If Yes to above, when approximately and in what program?
Your answer
When are you interested in enrolling? *
Required
Which class(es) are you interested in taking? *
Required
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
Race
Ethnicity
Do you have a
Highest Grade Completed
Your answer
Are you a single parent? *
Required
If yes to being a single parent, how many children are in your household?
Your answer
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?)
Are you a limited English speaker?
Please check any box(es) below if you wish to identify your specific limitations/conditions (All information is kept strictly confidential):
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? *
Required
If yes:
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) *
Required
Are you Single Head of Household? *
Required
Are you presently receiving income from any of the sources listed below? (please check all that apply) *
Required
How did you hear about the SUNY Syracuse EOC? *
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.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy