Fillable Undergraduate Web App12.09.16 (Eastern Oregon State College)

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Undergraduate Web App12.09.16 (Eastern Oregon State College)

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Eastern Oregon University
Application for Undergraduate 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
541-962-3393 or 800-452-8639
FAX: 541-663-9825
admissions@eou.edu
www.eou.edu/admissions
Application for Undergraduate Admission
Application deadlines: Fall: September 1 Winter: December 1 Spring: March 1 Summer: June 1
Admitted students are eligible to use federal financial aid and take more than eight credits per term. If you were previously admitted
and have not earned a degree, use the Returning Student Application. A non-refundable $50 application fee is required for all
applicants. To see if you qualify for a deferral, go to eou.edu/admissions/fee.
Year and term you plan to begin: Year _____ Fall _____ Winter _____ Spring _____ Summer _____
Student type:
New/freshman ___ Transfer ___ Post-baccalaureate ___ Federated States of Micronesia ___ National Student Exchange ___
Online _____ Regional center _____
_____
Personal information
Social Security Number __ __ __ __ __ __ __ __ __
Primary location: La Grande (main) campus
*See enclosed disclosure and consent statement.
Legal name as it appears on your social security card or passport.
Legal name ____________________________________________________________________________________________________
Last (Required) First Middle
Other name(s) that may appear on your academic records:
______________________________________________________________________________________________________________
Last First Middle
______________________________________________________________________________________________________________
Current mailing address (Required) City County/Province State (or country) Zip
______________________________________________________________________________________________________________
Permanent address (Required) City County/Province State (or country) Zip
______________________________________________________________________________________________________________
Home phone (Required) E-mail address
___________________________________________________________
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Check here to receive crucial information from EOU by text.
Cell phone
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Check here to receive EOU Emergency Alert System texts.
Emergency contact information: Please provide parent(s), legal guardian, relative or friend that can be reached in case of emergency.
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Parent(s)
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Legal guardian
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Other (specify) _________________________
______________________________________________________________________________________________________________
Last First Middle
______________________________________________________________________________________________________________
Mailing address City County/Province State Zip
______________________________________________________________________________________________________________
Primary phone Cell ___ Home ___ E-mail address
Your gender** Male ___ Female ___ Other ____ Your date of birth ______ / ______ / ______ Month/Day/Year
(Required)
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 applicants for admission. You are
encouraged to supply this information, but may decline without prejudicing your application in any way.
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Hispanic
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Non-Hispanic
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White, European American
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Asian American (specify ethnic group) __________________________
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Pacific Islander (specify ethnic group) __________________________
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Hispanic American (specify ethnic group) _______________________
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American Indian (specify tribal affiliation)
____________________________________________________________
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Alaska Native
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Black, African American
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Middle Eastern (specify ethnic group) _________________________
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North African (specify ethnic group) _________________________
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If none of the above is appropriate for you, please write in the
ethnic/racial identification you use _____________________________
`What is your military status?
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None
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Current/Active military
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Veteran
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Eligible dependent
**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.
* Social Security Number Disclosure and Consent Statement As an eligible educational institution, EOU must receive your correct social security number (SSN) to file certain returns with the IRS and to furnish
a statement 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.
Tuition classification for enrollment (must complete all information for correct tuition charges.)
Please answer the following. Failure to complete this section will result in a higher tuition classification and aect eligibility for
Oregon-based scholarships.
Select one:
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US Citizen
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In US on visa type_____
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Permanent resident (send copy of card)
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Resident of US Territory __________________
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Non US citizen
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Other (Please explain________________________________)
What is your state of residence? __________________________________________
If your state of residence is not Oregon, did you graduate from a state-recognized high school in Oregon, Washington or Idaho in the
last 3 years?
r
Yes
r
No
If your state of residence is not Oregon, did you enroll in an institution of higher education in Idaho or Washington at any time during
the last year preceding your intended entry term to EOU?
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Yes
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No
If yes, list school name and dates attended: __________________________________________________________________________
Oregon residency classification
Eastern Oregon University is required to collect state residency information for all students. An Oregon “resident for tuition purposes”
is a person who has, or a dependent person whose parent or legal guardian has lived in Oregon for at least 12 months without attend-
ing college as a full-time student.
Are you claiming Oregon residency?
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Yes
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No If yes, you must answer all the following questions for yourself:
Have you resided in Oregon for the last 12 consecutive months?
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Yes
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No
List the date the continuous presence in Oregon began? Mo/Yr ___/____
Please explain absence/presence less than one year ___________________________________________________________________
Do you have an Oregon driver’s license?
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Yes
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No Date of issuance? Mo/Yr _____
Did you or your spouse enter military service from Oregon?
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Yes
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No
Did you file tax returns in Oregon?
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Yes
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No If yes, list last two years filed _____/_____
If you are employed in Oregon, list name of current employer and city: ____________________________________________________
If you are under 24 you must answer all the following questions for parent or legal guardian:
Did a parent or legal guardian reside in Oregon for the last 12 consecutive months?
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Yes
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No
If yes, list the date the continuous presence in Oregon began? Mo/Yr _____
Did your parent or legal guardian enter military service from Oregon?
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Yes
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No Mo/Yr _____
Did your parent or legal guardian file tax returns in Oregon?
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Yes
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No If yes, list last two years filed _____/_____
If your parent or legal guardian is employed in Oregon, list name of current employer and city:
______________________________________________________________________________________________________________
Academic information
High school information: All undergraduate applicants must complete this section IF STILL IN HIGH SCHOOL. Contact your high
school and have an ocial transcript sent at the time of application and after graduation. (Applicants with foreign transcripts see
Freshman Policy and Procedures at eou.edu/admissions/freshman.)
_____________________________________________________________________________________________________________
Name of high school
Date of graduation: ________________
City/State
Cumulative unweighted GPA: _________________
Name of counselor ________________________________________________________ Phone _______________________________
If you have taken preparatory classes in 8th grade indicate here: Algebra I _____ Second language (specify) _________________
List your high school senior schedule of the following subjects:
English ___________________________ Math ____________________________ Science __________________________________
Social Studies _______________________________________ Second language __________________________________________
Alternative high school options:
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GED date of exam: ________ Average test score: ________
Home school (additional S
r
AT sub tests required.)
Please provide copy of ocial GED certificate.
Identify the test(s) you have taken or plan to take and the dates and submit ocial test scores. SAT/ACT scores are required for
scholarship consideration.
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SAT Reasoning Date of exam: ________
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SAT II Date of exam: ________ Score: SAT Composite ______
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ACT Date of exam: ________ ACT Composite ______
Colleges/universities 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.
Send ocial transcripts directly to the Oce of Admissions at Eastern Oregon University. (Applicants with foreign transcripts see
enclosed Transfer Admission Policy and Procedures.) For additional colleges, please attach a separate sheet.
Yr Mo Yr Mo City/State School Name
To From
Did you participate in Eastern Promise?
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Yes
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No
Enrolled
Degree received and
credits completed
What is your degree objective: Bachelor _____ Associate _____ Certificate _____
Primary major: __________________________________________________________________ Undecided _____
What is your career objective: ______________________________________________________ Undecided _____
**EOU Legacy: Did anyone in your immediate family attend EOU?
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Yes
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No
_____________________________________________________________________________________________________________
Name Relationship Year Degree earned
Did your parent(s) complete a 4-year college education?
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Yes
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No
**Activities you plan to be involved in at EOU:
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Music performance
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Theatre
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Student newspaper
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Student government
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Outdoor programs
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Varsity athletics (specify sport) _____________________
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Other ________________________________
**Have you visited campus?
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Yes
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No If yes, for what event(s)? ______________________________________ When? _________
**Primary language spoken at home? _______________________________________________________________________________
**How did you learn about EOU? ___________________________________________________________________________________
Signature required
A $50 application fee is required for all applicants. If I choose to defer my payment, and my deferment is denied, I am obligated to
pay the $50 application fee. This amount is added to my balance at Eastern Oregon University. I understand that deferral means I do
not need to pay the fee now, but obligated to pay the fee when I enroll for classes.
I certify the information on this application is correct and complete. I understand that withholding records of academic work or giving
false information is grounds for dismissal or denial of admission. I also understand that, whether or not I enroll, this application and all
other submitted documents will not be returned to me. (Please sign in ink. This application is valid for one year prior to matriculation.)
Signature: _____________________________________________________________________________________________________
Applicant’s signature Date
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My $50 application fee is attached
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I am deferring my payment
(To see if you qualify for a deferral, go to eou.edu/admissions/fee.)
Next steps: Submit ALL OFFICIAL HIGH SCHOOL AND COLLEGE TRANSCRIPTS
12/02/16
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Undergraduate Web App12.09.16 (Eastern Oregon State College)

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Completed 22 July 2020

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