Fillable Application for Undergraduate Admission (College of Eastern Idaho)

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Application for Undergraduate Admission (College of Eastern Idaho)

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Idaho State Board of Education Application for Undergraduate Admission 07-14-2016 Page 1 / 2
Application for Undergraduate Admission
to Idaho’s Public Colleges & Universities
For office use only
Mail the completed application or a photocopy along with the appropriate nonrefundable application fee(s) to each Idaho institution to which you are applying.
Applying to:
Boise State University
1910 University Dr.
Boise, ID 83725-1320
Fee: $50
1-800-824-7017
www.boisestate.edu
College of Southern Idaho
P.O. Box 1238
Twin Falls, ID 83303
Fee: None……………….Online Application
Fee: $10………………….Paper Application
(208) 733-9554
www.csi.edu
College of Western Idaho
One Stop Student Services, MS 3000
P.O Box 3010
Nampa, ID 83653
Fee: $25
(208) 562-3000
www.cwidaho.cc
Student Services, 1600 S. 25
th
E.
Idaho Falls, ID 83404
Fee: $15
1-800-662-0261
www.cei.edu
Idaho State University
Office of Admissions
921 S 8
th
Ave, Stop 8270
Pocatello, ID 83209-8270
Fee: $50
(208) 282-2475
Lewis-
Clark State College
500 8
th
Ave.
Lewiston, ID 83501
Fee: None
1-800-933-LCSC
www.lcsc.edu
North Idaho College
1000 W. Idaho Garden Ave.
Coeur d’Alene, ID 83814
Fee: No Application Fee
(208) 769-3311, option 5
www.nic.edu
University of Idaho
875 Perimeter Dr. MS 4264
Moscow, ID 83844-4264
Fee: None ……………Idaho Residents
Fee: $60……………….Non-Residents
1-888-884-3246
www.uidaho.edu
Start Date:
Fall, 20_______
Spring, 20_______
Summer, 20_______
APPLICANT INFORMATION
Legal Name:
Name You Prefer:
(as on Soc. Sec. Card) last first middle
Other Names Appearing on Records:
U.S. Social Security Number:
-
-
Date of Birth (mo/day/year):
Permanent Home Address:
Number & street / P.O. box city county state zip area code phone
Current Mailing Address:
Number & street / P.O. box city county state zip area code phone
Mailing Address valid until the following date:
/
/
Email Address:
GENERAL INFORMATION
Citizenship:
USA Other: __________
If you are not a US citizen, you will be required to provide proof of lawful presence in the United
States in order to qualify for Idaho residency for tuition purposes.
Native Language: English Other:______________________
Are you a U.S. Military Veteran?
Yes
No
Branch:
Service Dates:
to
Have you served in the U.S. Active Reserves?
Yes
No
Branch:
Service Dates:
to
Ethnicity:
Are you Hispanic or Latino?
Yes
No
Gender:
Female
Male
Race: (select one or more)
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Highest level of education or degree attained by either parent:
Bachelor
Other Degree:
Emergency Contact:
(For ALL to complete. If under 18, list parents or guardians here.) name relationship
number & street / P.O. box city county state zip area code phone
ENROLLMENT
INFORMATION
Intended Degree Type:
Certificate
Associate
Bachelor
Second Bachelor
Not Seeking Degree or Certificate
Program Type:
Academic Program
Career Technical Program
Intended Major: (Refer to each institution’s publication for a list of majors offered)
Undecided
first
second (optional)
Enrollment Status:
New
Transfer
Returning (readmission)
Do you plan to apply for federal financial aid?
Yes
No
College of Eastern Idaho
Idaho State Board of Education Application for Undergraduate Admission 06-08-2016 Page 2 / 2
Campus Location: If planning to take courses primarily at outreach locations, list these
locations:
___________________________________________
ACADEMIC INFORMATION
Have you taken the:
ACT: Date
SAT: Date
COMPASS: Date
List the last high school you attended and any schools since, including colleges, trade schools, correspondence, etc. Do not omit any schools. Attach a
separate sheet if more space is needed. Students seeking certificates or degrees must have official transcripts submitted from each school listed. To
be considered official, transcripts must be mailed in a sealed envelope directly from the school to the institution’s admissions office, or ordered and sent
electronically through the National Student Clear
inghouse.
Did/Will you graduate from high school?
Yes (month/year ) EduID: ___________________
No
High School:
City:
State:
Do you have a GED or high school equivalency certificate?
Yes (month/year )
No
If yes, degree-seeking applicants are required to submit official GED test scores.
Are/Were you a Tech Prep Student? Yes No
If yes, in which program area did you enroll?
PREVIOUS COLLEGE ATTENDANCE
Name of College, Trade School, etc.
City & State
Dates Attended
Grad. Date
Degree/# Credits Earned
RESIDENCY
Idaho residency for tuition purposes is governed by Section 33-3717B, Idaho Code and IDAPA 08.01.04. Residency for community colleges is determined
by county of residence under Idaho Code, 33-2110A.
State of Residence:
From:
to:
If less than 12 months, previous state:
County of Residence:
From:
to:
If less than 12 months, previous county:
Check applicable boxes: Documentation will be requested in order to verify Idaho residency for tuition purposes.
One or more of my parents/legal guardians is domiciled in Idaho and has maintained a bona fide domicile in Idaho for at least 12 months prior to the
opening day of the term which I plan to enroll, and I receive at least 50% of my financial support from my parents/legal guardians.
Parent’s name and address______________________________________________________ From to
I receive less than 50% of my financial support from parents/legal guardians. I have continuously resided in Idaho for purposes other than education for
at least 12 months prior to the opening day of the term which I plan to enroll.
I am married to an Idaho resident. My spouse is a resident of __________________________ County.
I (or my spouse) is a member of the Armed Forces stationed in Idaho on military orders. I (or my spouse) is stationed in ___________________ County.
I am an officer or an enlisted member of the Idaho National Guard.
One or more of my parents/legal guardians, from whom I receive 50% or more of my support, is a member of the Armed Forces of the United States who
entered servic
e as an Idaho resident and who has maintained Idaho resident status, but is not stationed within the state of Idaho on military orders.
One or more of my parents/legal guardians, from whom I receive 50% or more of my support, is a member of the Armed Forces stationed in Idaho. They
are stationed in ___________________________________ County.
I have been separated under honorable conditions from the Armed Forces after at least two years of service. Check one of the following:
At the time of separation, I designated the State of Idaho
as my intended domicile or indicated Idaho as my home of record, and I am entering this
institution within one year of the date of separation.
I intend to make Idaho my state of residence and will actively establish domicile within one calendar year.
I am/will be a graduate of an accredited secondary school in Idaho, am domiciled in Idaho, and will matriculate within six (6) years following my secondary
school graduation.
I completed six (6) years of elementary and secondary education in Idaho, am domicil
ed in Idaho, and will matriculate within six (6) years following my
secondary school graduation.
I am a member of one of the following Idaho Native American Indian tribes: Coeur d’Alene, Shoshone-Paiute, Nez Perce, Shoshone-Bannock, Kootenai,
Eastern Shoshone.
SIGNATURE
In signing this form, I acknowledge that failure to disclose and submit accurate information may result in denial of admission or dismissal from the institution. I certify that all
information provided is complete and true. Men between the ages of 18 and 25 must be registered with the Selective Service to be eligible for enrollment at a state college, to receive
state and federal financial aid, and to be employed in
a state or federal job. You may register with Selective Services online at http://www.sss.gov. By signing this application, I
certify that I am in compliance with the Federal Military Selective Service Act, 50 U.S.C. sec. 453, or that I am exempt from the same.
Acceptance or receipt of financial aid and scholarship awards certifies that the funds will be used for educational purposes.
Signature of Applicant:
Date:
Idaho public colleges subscribe to the principles and laws of the State of Idaho and the Federal Government, including applicable executive orders
pertaining to civil rights. These institutions are committed to the policy that all persons shall have equal access to programs and facilities without regard
to age, color, creed, marital status, national or ethnic origin, physical handicap, race, religion, or sex.
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Application for Undergraduate Admission (College of Eastern Idaho)

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Completed 5 November 2020

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