Revised 01/19
STEP 1 Please answer the following questions about yourself
1. _______________________________________________________________________________________________
First Name Middle Initial Last Name
2. Mailing Address: _________________________________________________________________________________
Street Address/Apt. #
_________________________________________________________________________________________________
City State Zip Code
3. KCC ID Number: _____________________ 4. Email Address: ______________________________________________
5. Home Phone Number: _____________________________ 6. Cell Phone Number:_____________________________
7. Date of Birth: ______________ 8. Gender: Female _____ Male _____
9. Ethnicity (Please check all that apply to you) A. Hispanic _____ B. American Indian or Alaskan Native _____
C. Asian _____ D. Black or African American _____ E. White _____ F. Native Hawaiian or Islander _____
STEP 2 Please answer the following questions about your parents and about yourself
10. Do either of your parents have a 2-year college degree? Yes _____ No_____
11. Do either of your parents have a 4-year college degree? Yes _____ No_____
12. PRIOR colleges you attended: _______________________________________________________________________
13. Number of college credits completed to date: ____________
14. Expected Degree or Certificate from KCC: _____________________________________________________________
15. Expected KCC graduation date: ____________________
16. Expected Degree from OIT: ______________________________________________________________
17. What career do you intend to pursue? _______________________________________________________________
18. How did you hear about the Badger to Owl connection (BOC) program?
___________________________________________________________________
STEP 3 Please answer the following questions about your educational plans
Klamath Community College
Badger to Owl connection (BOC)
Student Application
