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Career Exploration & Certificate Program
Powered by Victory XR -Metaquest Technology
Educational Opportunity Centers of PA
Department of Education TRIO Program
Career Program that you are registering for:
*
Please Select
Drones
Robotics
Carpentry
HVAC
Welding
Veterinary Science
Agricultural Science
Medical Assistant
Nursing Assistant
Ai Avatar Creation
Name
*
First Name
Last Name
Birthdate
*
Cell Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Citizenship Status
*
Please Select
US Citizen
Permanent Resident
I'd like to discuss
Ethnicity
*
Please Select
Hispanic or Latino
American Indian or Alaskan Native
Asian
Black/African American
White
Native Hawaiian/Pacific islander
Two or More Races
Gender
*
Please Select
Male
Female
Email
*
Prefer not a school email
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
What School District are you attending?
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Please Select
Hanover Area
Hazleton Area
Scranton School District
Shenandoah Valley
Wilkes-Barre
College Student
Parent of a Talent Search Participant
What is your current grade level:
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Please Select
7 grade
8 grade
9 grade
10 grade
11 grade
12 grade
college student
Adult interested
I am taking Dual Enrollment Classes
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Please Select
Yes
No
I want to
Household Taxable Income:
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Please Select
Household of 1: 0 to $23,940
Household of 2: $23,490 to $32,460
Household of 3: $32,460 to $40,980
Household of 4: $40,980 to $49,500
Household of 5: $49,500 to $58,020
Household of 6: $58,020 to $66,540
Household of 7: $66,540 to $75,060
Household of 8: $75,060 to $83,580
Households of more than 8: add $8,520 for each family member
Household income is:
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Above the family size amount
Below the family size amount
Unsure-I'd like help to figure it out
This is in reference to the Household Taxable Income in the Question above.
Parent Highest Education Completed
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Please Select
Middle School
current high school student
High School/GED
Associate Degree (2 Year)
Bachelor Degree (4 year)
Certificate
Graduate Degree
Educated outside the US
Unknown
My parent(s) completed a Bachelor Degree (4 year)
*
Please Select
Yes
No
Unknown
Signature
*
Read, Review, and Acknowledge:
I have read the VR Waiver and understand
*
Please Select
I give permission for my child to participate and use the VR Metaquest Goggles
I do not give permission
Date/Time of Submission
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