Careers with Nucleus 25.26

Career Exploration & Certificate Program

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Educational Opportunity Centers of PA

Department of Education TRIO Program
Career Program that you are registering for:
Name

First NameLast Name
Birthdate
Cell Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Citizenship Status
Ethnicity
Gender
Email
Prefer not a school email
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What School District are you attending?
What is your current grade level:
Highest Education Completed
U.S. Military Veteran?
My parent(s) completed a Bachelor Degree (4 year)
Household Taxable Income:
Household income is:
This is in reference to the Household Taxable Income in the Question above.
Access to Quality Tutoring: In order to maintain good grades or improve your grades in specific subjects, Educational Talent Search Program can connect you with quality tutoring opportunities. Should you wish to take advantage of these FREE tutoring opportunities-please contact your Talent Search staff or call our office at 570-331-6755.

My signature acknowledges that I am aware that I have access to quality tutoring in this program.
Signature
Date/Time of Submission
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Career Exploration & Certificate Program