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Graduate App2.28.17fillable (Eastern Oregon State College)

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Eastern Oregon University
Application for Graduate Admission
Eastern Oregon University is committed to providing
equal education opportunities to all qualified students
without regard to race, color, sex, national origin, age
religion, marital status, disability, veteran status, sexual
orientation, gender identity or gender expression.
Direct related inquiries to the Armative Action Oce,
Human Resources, One University Blvd., La Grande, OR
97850; phone 541-962-3548.
One University Blvd.
La Grande, OR 97850
541-962-3772
FAX: 541-962-3701
gradprograms@eou.edu
www.eou.edu
Graduate Programs
Please check the program that you wish to pursue.
Graduate Admissions
Application form
Type or print in ink. Submit application
to the Oce of Graduate Admission.
Application information
Students applying for admission to the
MS, MAT, MBA or MFA program will
need to apply separately to both EOU
and the specific graduate program.
Deadlines and information for applying
to the graduate programs can be ob-
tained through the links below.
www.eou.edu/mfa
www.eou.edu/cobe/business/mba
www.eou.edu/cobe/ed/mat
www.eou.edu/cobe/ed/ms
www.eou.edu/cobe/ed/sped
Ocial transcripts
Students will also need to have o-
cial transcripts sent from the college
granting the baccalaureate degree, as
well as ocial transcripts showing any
post-baccalaureate coursework. Stu-
dents who have earned, or will earn, a
baccalaureate degree from EOU will not
need to submit an ocial transcript.
International students
International students must use the
International Application.
www.eou.edu/admissions
Financial Aid
A student who is admitted as a grad-
uate student can only receive financial
aid for graduate courses. Undergraduate
courses cannot be included when deter-
mining a graduate student’s enrollment
status (full-time, half-time, etc.) for
purposes of financial aid eligibility.
Important Note for Graduate Students
If the student has received a bachelor’s
degree from an accredited institution
and wishes to enroll in more than eight
(8) credit hours of undergraduate or
graduate courses oered by the Univer-
sity, the student must file an Application
for Admission. The student must request
that an ocial transcript be sent to the
Oce of Graduate Admissions from the
college granting the bachelor’s degree,
as well as ocial transcripts show-
ing any post-baccalaureate work. The
student must list all colleges attend-
ed on the application. Admission as a
post-baccalaureate student, however,
does not constitute acceptance as a
candidate for a master’s degree. A
separate application for admission to
candidacy for the master’s degree must
be requested from the Graduate Oce.
College of Arts & Sciences
Master of Fine Arts (MFA) -
Creative Writing
College of Business
Master of Business
Administration (MBA) Onsite
Master of Business
Administration (MBA) Online
College of Education
Master of Arts in Teaching (MAT)
Master of Science Education (MS)
College of Education
Endorsement Preparation
Special Education
Graduate Literacy
Graduate ESOL
* Social Security Number Disclosure and Consent Statement
As an eligible educational institution, EOU must receive your correct social se-
curity number (SSN) to file certain returns with the IRS and to furnish a state-
ment to you. The returns EOU must file contain information about qualified
tuition and related expenses. Privacy Act Notice—Section 6109 of the Internal
Revenue Code requires you to give your correct SSN to persons who must file
information returns with the IRS to report certain information. The IRS uses the
numbers for identification purposes and to help verify the accuracy of your tax
return. For more information please refer to IRS code 6050S. You will be issued
a student ID number for your academic record at Eastern.
**This information will not be used for making admissions decisions. However,
you are encouraged to provide this information for data collection, application
processing, and research purposes.
Disability Services:
Eastern Oregon University is committed to providing educational opportunities
and appropriate support to students with disabilities. To assist us in our eorts,
students are requested, on a voluntary basis, to self-identify by contacting the
Disabilities Services Oce at 541-962-3081. The information will be kept confi-
dential and will be used only to provide reasonable accommodations in accor-
dance with section 504 of the Rehabilitation Act of 1973. Providing information
will not aect an applicant’s eligibility for admission.
Student Checklist. Please check (x) all that you have completed:
r
Check Social Security Number for accuracy.
r
Certify the accuracy of the information provided and sign your
application for admission.
r
Keep a copy of the entire application for admission.
r
Request ocial transcripts from your degree-granting institution and any
post-baccalaureate coursework.
r
Apply to graduate program through the appropriate department.
Application for Graduate Admission
You must also apply to the specific graduate program through the appropriate department. The Eastern Oregon University Gradu-
ate Admission deadline is the same as your specific graduate program deadline. Refer to the graduate program Web site for specific
dates. All admission application materials must be received by this date to be considered for admission. Failure to apply for admission
to EOU will result in ineligibility for graduate courses and to receive federal financial aid for the term in which you desire to attend.
Social Security Number __ __ __ - __ __ - __ __ __ __ EOU Student ID Number _______________________________or
*See disclosure and consent statement on previous page.
Academic information
Year and term you plan to begin: Year _____ Fall _____ Winter _____ Spring _____
_____
Summer _____
No _____Have you previously applied to or have you attended Eastern Oregon University? Yes
______ / ______ Last term attended:
Term Year
If yes, date of last application: ______ / ______
Term Year
Are you currently enrolled at a college or university? Yes _____ No _____
If yes, please name ____________________________________________________
Colleges attended:
List below every college and/or university you have attended or are currently attending whether or not credits were earned. Omitting
a prior college or university from this list may result in denial of admission or disciplinary action. You must request an ocial transcript
be sent to the Oce of Admissions from the college granting the baccalaureate, as well as ocial transcripts showing any post-bac-
calaureate work. If you have earned or will earn your baccalaureate from EOU, you do not need to submit an ocial transcript. Appli-
cants with foreign transcripts must submit an additional fee for transcript evaluation. For all international graduate applicants, please
e-mail international@eou.edu for more information. For additional colleges, please attach a separate sheet.
Yr Mo Yr Mo City/State School Name
To From Degree received or
expected and mo/yr
Enrolled
Legal Name ___________________________________________________________________________________________________
Las t First Middle
Other name(s) that may appear on your academic records:
_____________________________________________________________________________________________________________
Last First Middle
_____________________________________________________________________________________________________________
Mailing Address City County/Province State Zip
_____________________________________________________________________________________________________________
Permanent Address City County/Province State Zip
_____________________________________________________________________________________________________________
Primary Phone Cell ___ Home ___ Secondary Phone Cell ___ Home ___
r
Check here to receive crucial information from EOU by text.
r
Check here to receive EOU Emergency Alert System texts.
_____________________________________________________________________________________________________________
E-mail
Your Gender** Male ___ Female ___
Your Date of Birth** __________________ Month/Day/Year
Emergency Contact Information: Please provide a name of an individual who can be reached in case of an emergency.
_____________________________________________________________________________________________________________
Last First Middle
_____________________________________________________________________________________________________________
Mailing Address City County/Province State Zip
_____________________________________________________________________________________________________________
Primary Phone Cell ___ Home ___ Secondary Phone Cell ___ Home ___
_____________________________________________________________________________________________________________
Relationship
**Ethnic/Racial Identification: Please indicate your ethnic identity by selecting one of the following:
(Note: In compliance with federal reporting requirements, Eastern Oregon University must seek to identify the ethnic background of ap-
plicants for admission. You are encouraged to supply this information, but may decline without prejudicing your application in any way.
r
Hispanic
r
Non-Hispanic
r
White, European American
r
Asian American (specify ethnic group) __________________________
r
Pacific Islander (specify ethnic group) __________________________
r
Hispanic American (specify ethnic group) _______________________
r
American Indian (specify tribal aliation) _______________________
____________________________________________________________
r
Alaska Native
r
Black, African American
r
Middle Eastern (specify ethnic group) __________________________
r
North African (specify ethnic group) __________________________
r
If none of the above is appropriate for you, please write in the ethnic/
racial identification you use ____________________________________
Tuition classification for enrollment
Are you claiming classification as an Oregon resident?
r
Yes
r
No
If yes, completion of all questions in this section is required. If you
are under the age of 24, you must also complete the parent/guard-
ian section. Additional information may be required
Mother ___
Father ___
Your Information Guardian ___
Date of most recent
continuous presence
in Oregon (mo/yr)
______ to______ ______ to______
Original issue date of
Oregon Driver’s License _______________ ________________
______ to______ ______ to______
r
Yes
r
No
r
Yes
r
No
Dates of military
service, if applicable
Did you enter military
service from Oregon?
List last two years
Oregon Income taxes
have been filed ______ ______ ______ ______
Parent’s employer: 1. ________________ 2._________________
(if applicable) _________________ __________________
City/State City/State
from ______ to______
from ______ to______
Student’s employer: 1. ________________ 2._________________
(if applicable) _________________ __________________
City/State City/State
from ______ to______
from ______ to______
Other information required
Are you a citizen of the United States of America?
r
Yes
r
No International students must complete the Inter-
national Application.
If you are a permanent resident, please provide your Immi-
grant/Permanent resident number and attach photo copy:
A-________________________________________
What is your military status?
r
None
r
Current/Active Mili-
tary
r
Veteran
r
Eligible Dependent
If so, would you like information on services and benefits at
EOU?
r
Yes
r
No
Hometown newspaper: ______________________________
Certification: TO BE READ AND SIGNED BY THE APPLI-
CANT TO CERTIFY THE ACCURACY OF THE INFORMATION
PROVIDED.
Eastern Oregon University expects you to provide complete
and accurate responses to the items on this application for
admission. Further, the ocial documents that you submit
in support of this application must be authentic, unaltered
records that pertain to you. Your signature is your certifica-
tion of the accuracy and completeness of the information
you provide.
I certify the information on this application is correct and
complete. I understand that withholding records of academ-
ic work or giving false information is grounds for dismissal
or denial of admission. I also understand that, whether or
not I enroll, this application, the application fee, and all other
submitted documents will not be returned to me.
Signature: _________________________________________
Applicant’s signature Date
2.28.17
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Completed 22 July 2020

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