APPLICATION FORM
Year and semester you wish to begin the Advantage program: 20 ______ £ Fall £ Spring
Name: ___________________________________________ Preferred Name: _________________________
Last First Middle
Student Mailing Address: ____________________________________________________________________
Street Address
_________________________________________________________________________________________
City State Zip
Gender: £ Female £ Male Birth Date: ____/____/____ Expected Graduation Date: ____/____/____
Parent Phone: __________________£ Cell £ Home Parent Email: _______________________________
Student Phone: _________________ £ Cell £ Home Student Email: ______________________________
Country of Citizenship: __________________________ Country of Birth: _____________________________
If not a U.S. citizen, check type of visa: £ Student £ Permanent Resident £ Visitor £ Dependent
Is English your primary language? £ Yes £ No If no, what is? __________________________________
Name of parent(s) or guardian(s) with which you reside and relation to guardian(s) if applicable:
_________________________________________________________________________________________
Name(s)/Relation
Parent(s) or Guardian(s) Mailing Address: ______________________________________________________
Street Address
_________________________________________________________________________________________
City State Zip
Name of High School:______________________________ Phone: __________________________________
High School Address: _______________________________________________________________________
Street Address
_________________________________________________________________________________________
City State Zip
I arm that ORU has permission to discuss my academic progress with representatives from my school and send
my ORU transcript(s) to my school.
Student Signature: _____________________________ Parent Signature: ____________________________
SCHOOL’S APPROVAL TO ENROLL:
Counselor Name: _____________________________ Principal Name: _____________________________
Counselor Signature: __________________________ Principal Signature: __________________________