Buffalo EOC On-line Application

Thank you for applying to The University at Buffalo Educational Opportunity Center (EOC). Please complete the online application in its entirety. It is important that you provide a current email address, address and telephone number so that we can contact you regarding program eligibility.

Although you have completed the online application, you must still submit income documentation and educational documentation (for some programs) to the Office of Enrollment Management Services (EMS) in order to qualify.

Please do not hesitate to contact us if you have questions or requests for additional information or if you would like some assistance with the application.

EMS Office Hours: Monday, Tuesday, Wednesday, & Friday 8:30am – 5:00pm Thursday 8:30am – 7:00pm 716.849.6727 ext. 500

* denotes a required field

Your Program Interests
First program choice? *
Second program choice?
Preferred class time? *
Name and Contact Information
First Name *
Middle Initial
Last Name *
Address Line 1 *
Address Line 2
City *
State/Province *
ZIP/Postal *
Home Phone *	- -
Mobile Phone	- -
Email Address
Personal Information
Social Security	- -
Birth Date (mm/dd/yyyy)	/ /
Gender
Are you a NYS Resident 12 months or longer*
U.S. Resident Status *
Educational Information
What is your Diploma Status *
High School Attended
Have you ever applied for classes at EOC before? *
If Yes, when?
Have you ever enrolled in College? *
How many college credits do you have?
Have your ever enrolled in an EOP, HEOP, SEEK, or College Discovery Program? *
Employment and Income Information
What is your Job Status *
Are you legally entitled to work in the U.S.?
Are you the head of the household? *
Please enter amounts for all sources of income that apply to you or your "head of household". Leave blank or enter zero if none.
Employment (annual salary)	$
Social Services Home Relief (monthly)	$
Social Services TANF (monthly)	$
Disability Benefits (monthly)	$
Unemployment Benefits (monthly)	$
Social Security Benefits (monthly)	$
Veteran's Benefits (monthly)	$
Other Income (monthly)	$
Family Information
Are any of the following true of yourself or anyone in your household? Please answer all that apply.
Minor child under the age of 18 or under 19 and attending secondary school? (High School or equivalent level of vocational or technical training such as a BOCES)
A Pregnant Woman
Adult who is not the parent, but is a relative caring for a minor child?
A non-custodial parent of a minor child?
Emergency Notification
Please identify an adult relative or friend the EOC should contact if an emergency occurs while you are in school.
First Name *
Last Name *
Home Phone *	- -
What is your relationship *
What is their Primary Language *
How well do they speak English *
Do you live with this person *
Release and Application Declaration
The EOC may photograph or videotape students in a variety of school related activities. We request permission to use your photo in recruitment and promotional materials.
Do you authorize the EOC to use your photo? *

By submitting this application, I confirm that my application information is true and accurate to the best of my knowledge.

In accordance with federal and state laws, no person in whatever relationship with the State University of New York at Buffalo shall be subject to discrimination on the basis of age, religion or creed, color, disability, national origin, race, ethnicity, sex, marital status, or veteran status. Additionally, New York State Governor's Executive Order 28 and the University Board of Trustees Policy prohibit discrimination on the basis of sexual orientation.