1. Please Print or Type
2. Use Black or Blue Pen
3. Do not write in Shaded Areas
4. Abbreviate Where Necessary
ALL INFORMATION MUST BE COMPLETED
The following official documents are required for Admission. Any
exceptions must have the registrar’s Approval.
1. Completed Application for Admission Form
2. High School and/or College Transcript(s), or High School Equivalent
Scores
3. Results from ONE of the following: ACT, SAT, or RSC Assessment
Battery may be required.
4. Birth Certificate, Social Security, or State/Federal Identification card
Rose State College
Student ID Number (7 digits)
First Name Middle Name Last Name Other Name(s) under which your records may appear
Office of Admissions and Records
6420 SE 15th Street
Midwest City, OK 73110
Resident Status: Resident of Oklahoma?
How long? Years Months
Born in the United States
Born Abroad on Military Base
Naturalized Citizen
Permanent Resident
F-1 Student Visa
Other Visa Type or Status
To Be Answered by U.S. and Foreign Students:
English is my second language?
*Official documents required by the U.S. Citizenship and
Immigration Service, Oklahoma State Regents, and Rose State College
must be received and evaluated before an I-20 will be issued.
The following information is optional but is requested for reporting purposes
only in accordance with the 1964 Civil Rights Act, Title VI, as amended.
Do you consider yourself Hispanic or Latino?
Select one or more of the following categories to describe you.
Non Resident Alien Asian
Black or African American White
American Indian Native Hawaiian
or Alaskan Native or Pacific Islander
Tribe Bloodline: Mother
Father
Both
Are you the first person in your immediate family to attend college?
Term Entering
Fall
Spring
Summer
Employer
Work Phone
Hours worked per week
STUDENT’S MAILING ADDRESS
PARENT OR EMERGENCY CONTACT
Street Address City State County Zip Code
First Name Last Name Street Address City State/County Zip Code Phone Number
Social Security Number
Former RSC Student? Yes No Gender Male Female
Date of Birth
Month Day Year
Place of Birth
City State Country (if not U.S.)
Home Telephone Student’s Email Address
1. Active Duty U.S. Military:
2. National Guard or Reserves:
3. U.S. Military Veteran:
4. Dependent of National Guard or Reserve member:
5. Dependent of Active Duty U.S. Military member:
In what state is the active duty member stationed?
Were you (or are you the dependent of someone who was) discharged or released from Actve Duty military
service which lasted 90 days or longer within the past five years, currently residing in Oklahoma, and pursuing
a course of education under Chapter 30 (Montgomery GI Bill) or 33 (Post 9-11 GI Bill) VA educational benefits?
Yes No
Yes No
Supplying your Social Security Number enables a more expedient match of your test scores, transcripts, and financial aid benefits. You cannot receive Federal Financial Aid without providing
your Social Security Number.
Cell Phone
May we text you? Yes No
Yes No
Yes No
Year Entering
Yes No Branch of Service
Yes No Branch of Service
Yes No Branch of Service
Yes No
Yes No
Yes No
Citizenship Status:
If other status, please explain:
Application for Admission
