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EOC Intake Form Boston 2021-2022

All information is kept confidential.

Contact Information

Did your parents graduate from a U.S. 4-year college?

How many people are in your immediate family living with you? (Include yourself and all family members dependent on the income level selected above.)
Check all that apply
Financial Information
Select the range of your family’s Taxable income for LAST YEAR

I certify that this information is correct and understand that, by signing this form, I give permission to the Educational Opportunity Center to access my, or my son’s/daughter’s educational past and future enrollment information regarding schools/programs I/he/she has attended in order to track my, or my son’s/daughter’s educational progress. I authorize MassEdCO to contact me regarding MassEdCO’s EOC Program at the phone numbers that I or my son/daughter provide on this form or any future number that I provide for a cell phone or other wireless devices using automated telephone dialing equipment or artificial or prerecorded voice or text messages. I also consent to periodic emails to be sent to me or my son/daughter through email to any addresses that I or my son/daughter provide to MassEdCO.