High School Participant Application 2019-2020

Services Requested
Which TRIO services are you interested in receiving (check all that apply)?*

College Admission Assistance (includes colleges, universities, technical/vocational, or career education)Career AdvisingFinancial Aid Application Assistance (FAFSA, scholarship, defaulted loan rehabilitation, etc.)Financial Literacy Information (budgeting, understanding college costs, graduating with little student loan debt, college cost comparison, improving my credit score, etc.)College Transfer AssistanceOther
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Parent/Guardian Phone Number*

Area CodePhone Number
CERTIFICATION AND RELEASE
Read, sign and date:

I hereby authorize the Broward College TRIO Educational Opportunity Center (EOC) to disclose and/or receive access to the following types of information from my education records for the purpose of receiving services from Broward College’s TRIO EOC and for mandatory reporting requirements to determine program effectiveness. Services may include completing the Free Application for Federal Student Aid (FAFSA), college applications and participating in workshops that promote planning for, applying, enrolling and persisting in college. This information will include, but is not limited to, FAFSA data such as the Student Aid Report and other documentation reflecting FAFSA completion or National Student Loan Data System (NSLDS) information, documentation verifying high school graduation or equivalent secondary school completion documents such as diplomas and transcripts, and evidence of college application completion via Naviance, National Student Clearinghouse, and other applicable databases, acceptance letters, unofficial transcripts, schedules, verification emails, and other documents needed for the Broward College EOC program to meet reporting requirements from the U.S. Department of Education. My signature below certifies that the above information is correct to the best of my knowledge, that the below signature(s) belong to the intended party and is not forged, that I have a desire to pursue a program of postsecondary education (HEA SEC 402F & 34 CFR 644.3 (a)(3)), and that I am in need of support to successfully pursue/complete a program of postsecondary education.”
Parent Signature*

Clear
Use your mouse or mouse pad to sign the application. Signature must be clear.
Date*

MonthDayYear
Participant Signature*

Clear
Use your mouse or mouse pad to sign the application. Signature must be clear.
Date*

MonthDayYear
TRIO EOC is a 100% Federally funded program under the US Department of Education with a 2019-2020 annual budget of $263,529. For questions or other information, contact the EOC Director, Joevania Alexandre, at 954-201-4394 or via email at jalexan2@broward.edu.
Should be Empty:

High School TRIO Application

Demographic Information

Educational Information

Dependency Determination

First Generation & Income Eligibility

Services Requested