_____________________________________________________________________________________________________________
Mailing Address City County/Province State Zip
_____________________________________________________________________________________________________________
Primary Phone Cell ___ Home ___ Secondary Phone Cell ___ Home ___
_____________________________________________________________________________________________________________
Relationship
Your Gender** Male ___ Female ___ Other ___ Your Date of Birth (Required) ______ / ______ / ______ Month/Day/Year
**Ethnic/Racial Identification: Please indicate your ethnic identity by selecting one of the following:
(Note: In compliance with federal reporting requirements, Eastern Oregon University must seek to identify the ethnic background of ap-
plicants for admission. You are encouraged to supply this information, but may decline without prejudicing your application in any way.
r
Hispanic
r
Non-Hispanic
r
White, European American
r
Alaska Native
r
Asian American (specify ethnic group) __________________________
r
Black, African American
r
Pacific Islander (specify ethnic group) __________________________
r
Middle Eastern (specify ethnic group) __________________________
r
Hispanic American (specify ethnic group) _______________________
r
North African (specify ethnic group) __________________________
r
American Indian (specify tribal aliation) _______________________
r
If none of the above is appropriate for you, please write in the ethnic/
____________________________________________________________ racial identification you use ____________________________________
Tuition classification for enrollment
Are you claiming classification as an Oregon resident?
r
Yes
r
No
If yes, completion of all questions in this section is required. If you
are under the age of 24, you must also complete the parent/guard-
ian section. Additional information may be required
Mother ___
Father ___
Your Information Guardian ___
Date of most recent
continuous presence
in Oregon (mo/yr) ___/___ to___/___ ___/___ to___/___
Original issue date of
Oregon Driver’s License _______________ ________________
Dates of military
service, if applicable ___/___ to___/___ ___/___ to___/___
Did you enter military
service from Oregon?
r
Yes
r
No
r
Yes
r
No
List last two years
Oregon Income taxes
have been filed ______ ______ ______ ______
Parent’s employer: 1. ________________ 2._________________
(if applicable) _________________ __________________
City/State City/State
from ___/___ to___/___ from ___/___ to___/___
Student’s employer: 1. ________________ 2._________________
(if applicable) _________________ __________________
City/State City/State
from ___/___ to___/___ from ___/___ to___/___
Other information required
Are you a citizen of the United States of America?
r
Yes
r
No International students must complete the Inter-
national Application.
If you are a permanent resident, please provide your Immi-
grant/Permanent resident number and attach photo copy:
A-________________________________________
What is your military association? _____________________
Military Branch ___________________________________________
Status __________________________________________________
Enlistment Date ______________ Separation Date ______________
Disability Eligible _________________________________________
If so, would you like information on services and benefits at
EOU?
r
Yes
r
No
Hometown newspaper: ______________________________
Certification: TO BE READ AND SIGNED BY THE APPLI-
CANT TO CERTIFY THE ACCURACY OF THE INFORMATION
PROVIDED.
Eastern Oregon University expects you to provide complete
and accurate responses to the items on this application for
admission. Further, the ocial documents that you submit
in support of this application must be authentic, unaltered
records that pertain to you. Your signature is your certifica-
tion of the accuracy and completeness of the information
you provide.
I certify the information on this application is correct and
complete. I understand that withholding records of academ-
ic work or giving false information is grounds for dismissal
or denial of admission. I also understand that, whether or
not I enroll, this application, the application fee, and all other
submitted documents will not be returned to me.
Signature: _________________________________________
Applicant’s signature Date
1/19
Privacy Notice: EOU takes your privacy seriously and will only use your private infor-
mation to administer communication to you that includes information about admis-
sions, academics, financial aid, EOU Athletics and crucial deadlines relating to Eastern
Oregon University. EOU does not share your information with outside companies.
By signing this application, you agree to EOU storing and processing your personal
information for the above communication content.
click to sign
signature
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