Full Name: Address: Phone: School: Advisor: Years in EOC: Tell us a little bit about your-self; your goals, achievements, where you are currently in your career? How did you hear about EOC? What did EOC help you with? What obstacles do you feel you had to overcome to follow your educational goals? Is there anything else you would like to share with us about your experience at EOC? Please attach a current picture of yourself (if you do not have one, we will be contacting you shortly to schedule a time where we can take one) By signing below I give the Educational Opportunity Center at the Community College of Denver permission to use my story/image without reimbursement to me, for publication, electronic media, exhibition or any other appropriate purpose. So that the photographer can identify me correctly, my appearance can be distinguished by (describe identifying hairstyle, jewelry, or piece of clothing) Signature Date 3/17/2010 9:55:12 PM