EOP
APPLICATION
Return To: SUNY/Westchester Community
College, EOP Office, Attn: Alfred Quinones, Valhalla, NY 10595-1698
Click here for a
version of this form.
Student's Name_______________________ SS#___________________
Address_____________________________________________________
City_____________________________ State_____ Zip____________
Sex_______ Age_______ DOB__________
Phone (h)_______________(c)_______________ (w)______________
Email_______________________________________________________
Race:
___White (non-Hisp.) ___Puerto Rican
___Black (non-Hisp.) ___Other Hisp.
___Native American ___Asian or Pacific Islander
FINANCIAL AID DATA
Gross Income____________ P.A._________ S.S.__________ Ward of State ____________
Financial Status: Independent / Dependent (circle one)
Number of Dependants______ Household Size______
ACADEMIC DATA
Academic Year______ Acceptance Date: Fall____ Spring____
I plan to attend: Full-Time____ Part-Time____
My major will be__________________________________________
EOP Transfer__________ Previous EOP Semesters Used_______
High School______________ Date Graduated_______ Avg.______
GED (date)_________ Non-Grad____