EOP Application Referral

First Name

Last Name

Email Address

Have you been a New York state resident for 1 year?

Yes

No

Is (Was) your high school GPA between 70%-87%, 1.7 - 3.0, or C- to a B?

Yes

No

If you did not complete high school, did you earn a GED?

Yes

No

Did you participate in any college access or support programs? (For example: GEAR UP, Upward Bound, EOC, LPP, or similar programs.)

Yes

No

EOP Income Eligibility Guidelines:

Based on the chart above, are you eligible for EOP based your household income:

Yes

No

Have you ever lived in foster care or are you a ward of the court?

Yes

No

Are you or your family primarily dependent on public assistance? (e.g. SNAP, Supplemental Security Income, Temporary Assistance for Needy Families, or similar)

Yes

No

EOP Application Referral

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