Eastern Oklahoma State College

ONLINE APPLICATION FOR ADMISSIONS

Address: 1301 West Main, Wilburton, OK 74578 ~ Phone: 918-465-1813
Toll Free: 855-534-3672 ~ TDD Number: 800-522-8506 ~ Fax: 918-465-4491
Email: admissions@eosc.edu ~ www.eosc.edu

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FIRST-TIME STUDENTS MUST have the following in the Office of  Records Management/Registrar:

  1. Official high school and/or college transcript(s) or GED certificate
  2. ACT (or SAT) scores
  3. Completed admission application
  4. $15 enrollment fee

* DENOTES REQUIRED FIELDS - PLEASE FILL OUT FORM COMPLETELY.
I plan to enter Eastern in the year   Semester:

*Social Security Number   *Email Address  

*Last Name  *First Name   Middle Initial

Other names in which your records may appear:
   

Student Mailing Address: *Street   *City   *State  *

*Zip

Phone   Cell Phone

Which group best describes you? (optional information used for reporting purposes only)

If the answer was Other enter a description:

If the answer was American Indian enter your tribe:

Select Tribal Family Line:

Are you a veteran? Yes No  If yes, which branch of the military?

Residence Status

*Are you a citizen of the United States? Yes No   If no, what country?

Are you a resident of Oklahoma? Yes No If no, what state?   How long have you lived in Oklahoma?

Oklahoma-County  

Birth Info *Sex: *Month: *Date: *Year:   City:   State: *

Are you the first member of your family to attend college? Yes No
(The following information is voluntary and is requested for reporting purposes only)
Has either of your parents earned a 4 year degree? Yes No

*Name of High School *Graduation Date *Year *City of High School  

*State   Country *Zip   Phone   Councilor's Name  

Overall HS GPA (A=4.0)   Class Rank   out of  # of students 

*Please select which test you have taken. ACT SAT None

If you did not complete high school, did you complete a GED? Yes - Date:   No

*College Classification: If you were a *Former Eastern Student - semester/year attended
*Name when last attended

Educational goals while attending Eastern Oklahoma State College?
Are you working towards a degree? Yes No

Do you plan to graduate from Eastern? Yes No

Anticipated Major:

Associate of Applied Science (1 Year Certificates & 2 year Terminal Programs)

Associate in Science, Associate in Arts (2 year Transfer Programs)
LIST ALL COLLEGES AND UNIVERSITIES ATTENDED
Failure to list institutions previously attended may result in loss of credit or dismissal. Please submit official transcripts from each.
Name of School
City and State

Dates of Attendance
exp. 08/15/99 - 5/09/01
Date of Graduation
Degree Earned

Are you currently enrolled at another college/university? Yes No
Have you ever been dismissed or suspended from any college or university? Yes No
If yes where?
Have you ever been placed on academic probation? Yes No If yes, where?

Parents/Emergency Contact
Name
Address:
Phone:
Alternate Phone:
Relationship:





Name
Address:
Phone:
Alternate Phone:
Relationship:



I will/or have completed the Free Application for Federal Student Aid (FAFSA) Yes No

I have applied for OHLAP Yes No

I hereby affirm that all information supplied on this form is complete and accurate. It is my understanding that I shall not be considered for admission to Eastern until I submit all credentials specified. I understand that withholding requested information, except where it is voluntary for me to furnish the information or giving false information, will make me ineligible for admission and enrollment. If I am accepted as a student of Eastern Oklahoma State College, I agree to abide by the rules and regulations of the college.

Upon submitting this form you understand and agree to the statement above.

In accordance with federal, state and local laws, Eastern Oklahoma State College does not discriminate on the basis of race, color, age, religion, sex, national origin or physical handicap in its educational programs, activities, or employment practices.

In accordance with the Crime Awareness and Campus Security Act of 1990 and the Clery Law, Eastern Oklahoma State College has information available for prospective students and employees on crime prevention and statistics, policies on sexual misconduct, and policies on drug/alcohol use and possession. For more information, contact Eastern Oklahoma State College Campus Police at 918.465.1718, the Dean of Students, 918.465.1756 or view the report online at http://ope.ed.gov/security.

*Eastern Oklahoma State College follows all procedures as required by the Family Rights and Privacy Act of 1974.

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