Fillable Eastern Oregon University Applica Returning Student (Eastern Oregon State College)

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Eastern Oregon University Applica Returning Student (Eastern Oregon State College)

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  • 8 check-boxes
  • 97 other fields

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File type: PDF

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Eastern Oregon University
Returning Student
Applica
tion
A returning student is one who has been admitted and has attended classes at Eastern Oregon University, has been absent for more than
three academic terms and has not received a degree. This application is for degree seeking students or students taking pre-requisites for a
graduate program. Students who received a degree from Eastern Oregon University and are applying for graduate status for the first time
should use the Application for Graduate Admission.
Social
Security
Number
*See enclosed disclosure and consent
s
ta
t
ement.
or Student ID Number
Academic
inf
orma
tion
Y
ear and
t
erm
y
ou
plan
t
o
r
e-ent
er:
Y
ear
F
all
W
int
er
Spring
Summer
S
ta
tus: Under
gr
adua
t
e
P
os
t-bac
calaur
ea
t
e
Gr
adua
t
e
Primary
loca
tion:
La
Gr
ande Campus
Online
R
egional
C
ent
er
W
ha
t
is
your
degr
ee
objectiv
e:
Bachelor
Associa
t
e
C
ertifica
t
e
Intended major/program(write unknown if needed):
BS
BA
Intended minor and/or concentration
Last term/year at EOU
Have you
a
tt
ended
or are you currently
a
tt
ending
any college(s) since you
las
t
a
tt
ended
EOU?
Yes
No
If yes, list all colleges. Official transcripts from colleges attended must be sent to the Registrar’s Office at EOU prior to being readmitted.
Name of college(s)
City
/
S
ta
t
e Dates of Attendance
Personal
inf
orma
tion
Legal Name
Last First Middle
Other name(s)
that
may appear on your academic
r
ec
or
ds:
Las
t
Firs
t
Middle
Y
our
Da
t
e
of
Birth
**
/
/
Month/Day
/Y
ear
Current Mailing Address City
County/Province
S
ta
t
e
(or
country)
Zip
Permanent Address City
County/Province
S
ta
t
e
(or
country)
Zip
Primary
Phone
C
ell
Work
E-mail
addr
es
s
Emergency Contact Information: Please provide parent(s), legal guardian, relative or friend
that
can be reached in case of emer
genc
y
.
P
ar
ent(
s
)
Legal
guardian
other
(
specify)
Las
t
Firs
t
Middle
Mailing Address City
County/Province
S
ta
t
e
Zip
Primary
Phone
C
ell
Work
E-mail
addr
es
s
Tuition classification for enrollment
(Mus
t
complete thoroughly for correct tuition
charges.)
Are you a citizen of the United
S
ta
t
es
of America?
Yes
No
Other
If
no
,
are you a permanent resident of the United
S
ta
t
es
of America?
Yes
No
If a permanent resident, provide your
immigrant/permanent
resident number and submit a
phot
ocopy
.
If
not
a
U
.S.
citiz
en
or
a
U
.S.
permanent
r
esident,
wha
t
is
your
c
ountry
of
origin
?
W
ha
t
is
your
s
ta
t
e
of
r
esidenc
e
?
If your
s
ta
t
e
of residence is not Oregon, did you
gr
adua
t
e
from a
s
ta
t
e
recognized high school in Oregon, Idaho or Washington in
the
las
t
three years?
Yes
No
If your
s
ta
t
e
of residence is not Oregon, did you enroll in an
institution
of higher education in Idaho or Washington
at
any time
during
the
las
t
year preceding your intended entry
term to
EOU?
Yes
No
If
y
es,
lis
t
school
name and da
t
es
a
tt
ended:
Oregon residency classification:
Eas
t
ern Oregon University is required
to
collect
s
ta
t
e
residency
information
for all students. An
Or
e
gon
“resident for tuition purposes: is a person who has, or a dependent person whose parent or legal guardian has, lived in Oregon
f
or at
leas
t
12
months,
without
a
tt
ending
college for more than 8 credits hours during a single quarter
.
Are you claiming Oregon Residency?
Yes
No
If yes, you mus
t
answer all the
following
questions for
y
ourself:
Have you resided in Oregon for the
las
t
12
consecutive months?
Yes
No
If
y
es,
lis
t
the
da
t
e
the
continuous
pr
esenc
e
in
Oregon
began
?
Mo/Y
r
Do you have an Oregon driver’s license?
Yes
No
Da
t
e
of issuance?
Mo/Y
r
Did
you or your spouse enter military service from Oregon?
Yes
No
Did
y
ou
file
tax
r
eturns
in
Oregon
?
Y
es
No
If
y
es,
lis
t
las
t
tw
o
y
ears
filed
/
If
y
ou
ar
e
emplo
y
ed
in
Or
egon, lis
t
name
of
current
emplo
y
er
and
city
.
If you are under 24 you mus
t
answer all the
following
questions for parent or legal
guar
dian:
Did a parent or legal guardian reside in Oregon for the
las
t
12 consecutive months?
Yes
No
If
y
es,
lis
t
the
da
t
e
the
continuous
pr
esenc
e
in
Oregon
began
?
Mo/Y
r
Did your parent or legal guardian enter military service from Oregon?
Yes
No
Did
your
par
ent
or
legal
guardian
file
tax
r
eturns
in
Oregon
?
Y
es
No
If
y
es,
lis
t
las
t
tw
o
y
ears
filed
/
If
your
par
ent
or
legal
guardian
is
emplo
y
ed
in
Or
egon, lis
t
name
of
current
emplo
y
er
and
city
W
ha
t
is your military status? None
Current/Active
Military
Veteran
Eligible
Dependent
**Y
our
hometown
ne
w
spaper:
Signature
r
equir
ed
I certify the
information
on this
application
is correct and
c
omplet
e
.
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
)
Signa
tur
e:
Applicant’s signature Date
* Social Security Number Disclosure and Consent
S
ta
t
ement
As an eligible educational
institution,
EOU mus
t
receive your correct social security number (SSN)
to
file certain returns with the IRS
and
to
furnish a
s
ta
t
ement
to
you. The returns EOU mus
t
file contain
information
about qualified tuition and
r
ela
t
ed
expenses. Privac
y
Act Notice—Section 6109 of the Internal Revenue Code requires you
to
give your correct
SSN
to
persons who mus
t
file
inf
orma
tion
returns with the
IRS
to
report certain information. The
IRS
uses the numbers for
identification
purposes and
to
help verify the ac
cur
a
-
cy 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
Eas
t
ern Oregon Univ
ersity
.
Timeline: Readmission may take several days
to
review once all documents have been received. You will be notified through your EOU
E-mail account or through postal mail when your admission has been
r
eins
ta
t
ed
and are eligible
to
r
egis
t
er
.
Eas
t
ern
Oregon
Univ
ersity
Registrar’s Office
105 Inlow Hall University
Blv
d.
La Grande, OR
9
7
850
541-962-3607or Fax:
54
1-962-3799
E-mail:
registrar
@eou.
edu
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Eastern Oregon University Applica Returning Student (Eastern Oregon State College)

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Completed 23 July 2020

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