Please complete and submit the following form.  An academic advisor 

from Southwest Ohio Educational Opportunity Center will contact you.

Registration Form  (The following information will be used to determine eligibility for services from SOEOC.)

Please check the appropriate box for each question below.

Sex

Female    Male

Age

14-18            19-27            28+

Ethnic Background

American Indian        Asian        African American      

Hispanic                     Pacific Islander           White

Are you a U.S. citizen?        Yes        No    Permanent Resident

Is English your native language?    Yes    No

Do you have a disability?        Yes        No

Are you a veteran?        Yes        No

Did either of your parents receive a four-year college degree?     

Mother        Father   Both        Neither  

What type of school are you interested in attending?

Vocational / Technical School

2-Year College

4-Year College

When do you plan to start school?

  Fall  Winter  Spring    Summer

What do you need in order to begin or continue your 

postsecondary education?

Financial Aid help

Admissions help

Career Search help

Admission Test help

Educational Support:  Academic Advising, Study Skills instruction, 

     Postsecondary Orientation, Mentoring, Tutoring

How did you find the Southwest Ohio Educational Opportunity Center website?

By submitting this form, I certify that to the best of my knowledge 

all the information provided here is current and accurate.  

I grant SOEOC permission to provide advising services and 

maintain a confidential file.  I authorize the use of this information 

for reporting and I understand my identity will not be revealed.