Career Exploration Program

Thank you for your interest in our Amazing Career Exploration Program.

Each month, EOC provides opportunities to learn and explore different career sectors. Sign up for as many as you are interested in!

Student Section

Career Exploration Options: *

Interested in more than one career? List the others here:

Last Name *

First Name *

Address *

City *

Instructions for delivery of career exploration supplies:

Ethnicity *

Date of Birth *

Cell Phone *

Gender *

Email (Not School) *

Are you Participating in another Other Federal Program

___________________________________________________________________________________________________________________________________________

Academic Information about Student

Current Grade Level *

Current School *

Dual Enrollment *

Current Age: *

Career Goal

_______________________________________________________________________________________________________________________________________

Parent/Guardian Permission

Parent/Guardian Name *

Parent/Guardian Mobile Phone *

Contact 1 Email *

Parent/Guardian #1 Highest Education Completed *

Parent/Guardian #2 Highest Education Completed *

Marital Status *

Household Size *

Household Income Range *

Household Income is:

Is anyone in the Household Receiving any of these benefits:

I would like to become a member of the EOC Program & participate in this activity:

______________________________________________________________________________________________________________________________________

Many activities include career specific items:

package can include nut or nut related items;
medical mentorship program includes dissection activities

by signing-I understand that it is my responsibility to address any potential allergy items. And I assure complete respect of all materials used for these activities.

Access to Quality Tutoring:

In order to maintain good grades or to improve your grades in specific subjects, the Educational Talent Search Program is committed to connecting you with quality tutoring opportunities. Should you wish to take advantage of these FREE tutoring opportunities-please contact your EOC Staff Member (570 331-6755 or visit our website: eocinc.org/tutoring/

My signature acknowledges that I have provided accurate information in this application and I am aware that I have access to quality tutoring.

Sign and Submit

Student Signature *

Please select a signature verification type.

Parent/Guardian Signature *

Please select a signature verification type.