APPLICATION FOR ADMISSION
900 N. Portland Ave., Oklahoma City, OK 73107
(800) 560-4099 l (405) 947-4421 l firstname.lastname@example.org
TERM IN WHICH YOU PLAN TO ENROLL
________________Year □ Fall □ Spring □ Summer □ Intersession
STUDENT SS # LEGAL NAME - LAST FIRST MIDDLE
DATE OF BIRTH OTHER NAMES EMAIL ADDRESS
MAILING ADDRESS CITY STATE ZIP HOME PHONE CELL PHONE
( ) - ( ) -
GENDER: o MALE o FEMALE
DO YOU CONSIDER YOURSELF TO BE HISPANIC/LATINO? YES___ NO___
SELECT ONE OR MORE OF THE FOLLOWING CATEGORIES TO DESCRIBE YOURSELF:
o American Indian or Alaska Native o Asian o Black or African American o Native American or Pacific Islander o White
PLACE OF BIRTH NEXT OF KIN/EMERGENCY CONTACT
Name _____________________________________ Phone ______________________________
City State Country Address _____________________________________ Email _____________________________
EDUCATIONAL OBJECTIVE MAJOR FIELD OF STUDY
Choose the option applicable to your current goals:
I plan to earn a degree at OSU-OKC. □ A.A.S. (08) □ A.S. (06) □ B.T. (01) See major list for proper name
□ I plan to complete my basic coursework here and earn a bachelor’s degree at another college. (02)
□ I plan to earn a certificate at OSU-OKC. (12)
□ I plan to earn an Associate’s degree at another institution. (15)
□ I am taking courses for personal improvement or general interest. (11)
□ I am taking courses to build my job skills. (14)
How did you hear about OSU-OKC?
□ 1 – TV □ 2 – Radio □ 3 – Web Site □ 4 – Newspaper □ 5 – Campus Recruiter
□ 6 – High School Counselor □ 7 – Alumni Influence □ 8 – Friend □ 9 – Other___________________
Number of persons in household______ Which of your parents has a four-year college degree? □ Mother □ Father □ Neither
Household Income*: □ $0 - $22,000 □ $22,000 - $30,500 □ $30,500 - $38,500
□ $38,500 - $48,500 □ $48,500 - $57,000 □ $57,000 +
How long will you have lived in the state of Oklahoma immediately preceding your enrollment at OSU-OKC?
_________ / ___________ Date moved to Oklahoma _________ / ___________
Years Months Month Year
Are you active military, or dependent, assigned to Oklahoma? □ Yes □ No If yes, list home state_________________
Are you a citizen of the United States? □ No
□ Yes Do you have permanent resident status? □ Yes □ No
Are you in the United States on a nonimmigrant visa? □ Yes □ No
If yes, what type of visa? ________________________________ Country of Citizenship _______________________________
What is your native language? □ English □ Other ________________
If English is not your native language, have you taken the: □ TOEFL □ IELTS If yes, date(s) taken: _________________
(TOEFL - Test of English as a Foreign Language l IELTS - International English Language Testing System)
OFFICE USE ONLY
W NW REQ.________DEGREE____________DEPT.___________ COND.________ CMPS____________ADM REP.________
OSU-OKC APPLICATION FOR ADMISSION page 2 of 2
Last high school attended___________________________________________________________________________
High School Diploma: □ Yes – Year__________ □ No (OR) GED: □Yes – Year ___________ □ No
ACT/SAT: □ Yes – Mo.______/ Year__________ □ No
List all colleges currently attending or previously attended in order of last to first. Official transcripts of all college work
attempted (whether or not credit was earned) must be submitted. If no other colleges or universities have been attended
College Name City, State Dates Attended Hours Earned Degree Received
If additional colleges have been attended, please list on a separate sheet. Total Hours Earned _________
My academic standing at the most-recently attended institution was: □ Good □ Probation □ Suspension
If you are enrolling in a cooperative program with an Oklahoma Technology Center, please indicate which Center:
□ Canadian Valley □ Eastern Oklahoma County
□ Francis Tuttle □ Metro Tech
□ Moore Norman □ Kiamichi
Company Name __________________________________________________________ Work Status □ Full-time □ Part-time
City State Zip Work Phone
FINANCIAL AID OR VETERANS BENEFITS
Please note: All students receiving financial aid and veterans receiving benefits are required to submit official transcripts
from all previous institutions.
Are you currently eligible for veterans benefits? □ Yes □ No
Have you applied for and/or will you be receiving financial aid? □ Yes □ No
□ I understand that withholding requested information or giving false information may make me ineligible for admission
to, or continuation at, OSU-Oklahoma City.
□ If I am currently enrolled in high school or college, I will furnish final, official transcript(s) within two weeks of the end
of the semester.
□ I agree to fulfill all financial obligations which I may incur at OSU-OKC.
□ I will comply with all Board of Regents and institutional policies and procedures.
□ I will provide official transcripts, test scores and any other required documentation.
Review this application carefully to make sure all information is complete and accurate. An incomplete application will result in a delay
in the admission/enrollment process.
*Optional Information breathe easy