Northeastern Oklahoma A&M College
Boys’ State 2020
Enrollment Form
Please mail the application and tuition & fee payment by May 29, 2020 to:
NEO A&M College Admissions Office P.O. Box 3843 Miami, OK 74354-6497
Fax: (918) 540-2656 ~ Email: neoadmission@neo.edu
PLEASE PRINT CLEARLY:
Social Security Number_______________________Full Legal Name_________________________________
Current Mailing Address___________________________City & State____________________Zip_________
Home Phone (______)____________________________ Cell Phone(_____)__________________________
Email Address:____ _______________________________________________
Birth Date_______________________________________Birth City & State___________________________
U.S. Citizen q Yes q No Permanent State Residence___________________County_________________
Next of Kin __________________________Relationship to you _________ ________________
Next of Kin Contact Address__________________________City & State_____________ __Zip _________
Next of Kin Contact Phone(____)_ _______________Type of phone q Cell q Home q Business
Ethnicity: q Not Hispanic q Hispanic q Unknown
Ethnic Classification: q African-American q Asian q Caucasian q Hispanic
Native American (Specify tribe)_______________________________Bloodline: Mother Father
High School:______________________________________City & State______________________________
High School Graduation Date:___________________ Anticipated College Major: _ ______________
NEO A&M College is committed to compliance with the letter and the spirit of the requirements of the Americans with Disabilities Act (PL.101-336) and will continue its
practice of non- discrimination against the disabled in education and in their access to the facilities, programs and services of the College. For further information or to
request accommodations for physical or learning disabilities, you may contact the ADA Coordinator in the Office of Student Affairs, Shipley Hall room 309, or call
540-6969.
I permit this information to be released in the case of emergency. Yes No I certify all information provided here is correct. I understand any falsification is cause
for immediate cancellation of registration and/or dismissal from Northeastern Oklahoma A&M College Campus.
I also understand that there will be a financial obligation to the College for this class and agree to pay for tuition and fees incurred for this class.
Signature: _____________________________________________________ Date: _________________________
Parent/Guardian Signature: ________________________________________ Date: _________________________
Please indicate which college credit course you choose to receive credit for:
(Parent/Guardian signature is required for the student, if under 18, to
enroll in either credit hour option.)
_____ 2-credit hour course - POLS 1012 Oklahoma State & Local Government
(Cost - $335.50 tuition & fees or $137.50 tuition & fees with qualifying tuition waiver)
(Fees are subject to change without prior notice)
_____3-credit hour course - POLS 1013 Oklahoma State & Local Government
(Cost - $503.25 tuition & fees or $206.25 tuition & fees with qualifying tuition waiver) (Fees are subject to change without prior notice)
All Boys’ State participants are eligible for credit. However, to receive the tuition waiver,
you must qualify as a concurrent student, submit signed consent form, high school
transcripts, and ACT scores. (see flyer for concurrent qualifications).
COLLEGE CREDIT CANNOT BE RECEIVED, CANCELLED AND NO REFUNDS MAY BE ISSUED AFTER MAY 29, 2020.
Revised 06-2019
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