TRIO EOC

INCOME VERIFICATION

As parent or guardian of:
Social Security Number *
First Name (STUDENT'S NAME)
Last Name (STUDENT'S NAME)
Date of Birth *
Which high school do/did your student attend?
How many people are in your family??
What is the Adjusted Gross Income Range of your Family (Most Recent Tax Return line 11)? *
What is your Family's Taxable Income Range (Taxable Income is Adjusted Gross Income Minus your Standard Deduction) (Most Recent Tax Return line 15) *
Which high school do/did you attend?,
Which Standard Deduction Did you Parents Use when filing their Tax Return (Most Recent 1040 Line 12)?
By providing my signature electronically, I am certifying that I give permission for my student to participate in the EOC Trio Program and that the income information presented above is accurate to the best of my knowledge:
Parent or Guardian Signature *
Signature Type: Simple    Start Over
Click here to start signing.
  • Pencil
  • Reset
Signature: (Type in your full name)
I agree to the terms included.

The EOC program at UA Rich Mountain is funded in total (100%) by federal grant funding from the U.S. Department of Education with an annual budget of $505,798.