TRIOPilot

627 SW 27th Avenue, Room 1111 Miami, FL 33135
Office: 305-237-6488 • Email: trioeocmiami@mdc.edu

The Educational Opportunity Center of Miami Dade College is a federally funded TRIO program with the mission of providing secondary and postsecondary information and assistance to eligible adults in Miami-Dade County at NO COST. My signature below indicates that the information I have provided above is accurate and verifiable to the best of my knowledge. All information will be kept confidential. By signing, I understand that the information on this form will be used for statistical and client service purposes and is protected by FERPA. I authorize any school, college, university or continuing education to release the academic information requested by MDC TRIO Educational Opportunity Center.

Student Information PARTICIPANT APPLICATION INFORMATION

1.What is your immigration status?*

This helps us check your eligibility for federal student aid.

.Upload a photo of the front of your Green Card

A photo taken with your phone is fine. Please make sure all four corners show and the writing is easy to read.

Tap to upload or take a photo

Images or PDF, up to 10 MB

.Upload a photo of the back of your Green Card

Take this one the same way as the front, with all four corners showing and the writing easy to read.

Tap to upload or take a photo

Images or PDF, up to 10 MB

2.First Name*

3.Last Name*

4.Email Address*

5.Mobile Phone*

6.Date of Birth*

7.Home Address*

Start typing your address and select from the suggestions.

8.Sex*

MaleFemale

9.Are you Hispanic or Latino?*

YesNo

10.Household income and family size*

We use this to check whether you meet the income eligibility guideline.

Household Size (# of people)

Household Income

11.Does either of your parents or guardians hold a bachelor's degree?*

Answering "No" means you qualify as a first-generation college student.

YesNo

12.As of today, what is your level of education?*

.What college or university do you currently attend or did you most recently attend?

Start typing to search; choose your school from the list, or type its name if it is not listed.

.What is your student ID?

.What high school do you attend or did you most recently attend?

Enter the name of your high school.

13.Do you have limited English proficiency?*

YesNo

14.Are you a veteran or otherwise connected to the military?*

15.Are you receiving services from another federally funded TRIO program? *

YesNo

16.Have you lived in the state of Florida for one year or longer? *

YesNo

17.Please select ALL the services you need: *

.What other services do you need?

.Other:

19.May we send you text messages about the program?

By selecting Yes, you agree to receive text messages from Miami Dade College EOC at the number provided (e.g. appointment reminders and program updates). Consent is not a condition of receiving services. Message frequency varies. Message and data rates may apply. Reply STOP to opt out or HELP for help. View our Privacy Policy and Terms of Service.

YesNo

20.Parent Name (if student is under 24 years old)

21.Parent Phone Number (if student is under 24 years old)

22.Parent E-mail (if student is under 24 years old)

By clicking "Submit Application" below, I hereby authorize Miami Dade College TRIO Educational Opportunity Center (TRIO EOC) to access and release educational and financial records. The request for access to participant information and records is for the sole purpose of assisting the participant through the process of enrolling into a post-secondary institution. This process may include one or all the following services: sharing of resources to improve financial and economic literacy, counseling on financial aid options, basic financial planning skills, and assistance with federal student aid applications, vocational school applications or college applications. Records may include: all grades, all courses/credits, all class schedules, test scores, graduation information, immigration information, financial information, income tax information, status of postsecondary admission, and status of postsecondary enrollment. The request for release of information is for the purposes of research, recruitment, promotion and reporting as it pertains to program objectives and outcomes. Name of Agency to whom personal identifiable information may be released to: TRIO Educational Opportunity Center (TRIO EOC), Miami Dade College school officials, and the United States Department of Education. Non-personal identifiable information may be disclosed to: National and state TRIO associations, community agencies, donors, researchers, recruitment, and promotional material. This authorization will remain continuously in effect until I with draw this authorization in writing or for a maximum of four years. If the participant is not at least 18 years old, the parent or legal guardian of the participant must sign this release.

Miami Dade College EOC is a federally funded TRIO program that provides educational guidance and services to eligible participants at no cost. My signature below indicates that the information I have provided above is accurate and verifiable to the best of my knowledge. All information will be kept confidential. By signing, I understand that the information on this form will be used for statistical and program service purposes and is protected by FERPA. I authorize any school, college, university, or continuing education institution to release the academic information requested by Miami Dade College EOC.

23.Participant OR Parent/Guardian’s signature:*

Draw your signature above

By signing, I affirm that all information provided in this application is accurate and complete to the best of my knowledge.

By clicking "Submit Application" below, I certify that all statements given in this application are true and accurate to the best of my knowledge.

Program Application