Thank you for your interest in our EOC program!  Please complete this application as thoroughly as possible.  You cannot save and restart this application.  You may want to review the included items, take some time to make notes and gather the required documents, and then return to submit your application.  If you have any questions, please call our office at 319-784-1717
General Information:
First Name *
Last Name *
Preferred Name
Middle Name
Date of Birth *
Ethnicity *
Citizenship
Gender *
Address *
Address 2
City *
State *
ZIP Code *
Home Phone
Cell Phone *
Email *
Additional Info:
Current Grade Level *
Current Age *
Language Preference
Communication Preference
How did you hear about EOC?
Are you connected to the Military? *
Family Information:
Parents Educational Level *
How many people in your household? *
Household Income Range
Most Recent IRS 1040 - You may submit later in person.
Sign and Submit:
Sign Here *
Signature Type: SMS    Start Over
After validation, the cell phone number will become part of the electronic signature.
Cell Phone Number: