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Educational Opportunity Center Participant Intake Form

If you are interested in services provided by the Educational Opportunity Center (EOC) at Delta, please complete the information below. 

All information must be provided to determine eligibility for EOC services. All information will be kept personal and confidential. 

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Personal Information

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Household Information

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Educational Background

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Agreement & Signature

Please read each statement below, then sign and date.

I give permission to the Educational Opportunity Center program and staff to obtain, review, discuss and copy all records and information available through my previous schools (high school, college/university, etc.) including but not limited to academic records, financial aid records and to release information to the U.S. Department of Education and Delta College. All information obtained by the Educational Opportunity Center is completely personal and confidential and will only be used for verification of eligibility to this program.

The Educational Opportunity Center program and staff have my permission to communicate verbally, in writing, by email, or other means to share information with Delta College faculty, staff, departments and/or off-campus professionals.

The Educational Opportunity Center program and staff have my permission to submit on an annual basis my name, date of birth and social security number to the National Student Clearinghouse to verify enrollment and degree information.

Being permitted to participate in activities and usage of equipment and facilities, I agree to indemnify and hold harmless the Educational Opportunity Center program and Delta College from any and all claims which are in any way connected with such use or participation in the program.

By checking the box and typing my name below, I certify that all information provided on this form is true and complete. 

 

It is the policy of Delta College and the Education Opportunity Center not to discriminate in employment, education, public accommodation, or public service on the basis of age, arrest record, color, disability, ethnicity, familial status, gender identity, genetic information, height, marital status, national origin, race, religion, sex, sexual orientation, veteran status, and weight. Direct inquiries to the Equity/Compliance Officer, Delta College, Office A093, 1961 Delta Rd., University Center, MI 48710, telephone 989-686-9547, or email equityoffice@delta.edu.

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