ECU Student Application

APPLICATION FOR ADMISSION / READMISSION

Office of Admissions and Records
1100 E. 14th Street, ECU PMB J8
Ada, Oklahoma 74820-6999
580-332-8000
e-mail: registrar@ecok.edu

Each student who plans to enter East Central University for the first time must have all the following on file in the Office of Admissions and Records:

If an undergraduate student, your ACT report, a current official transcript from your high school and college(s), and a copy of your current schedule. High school transcript should indicate GPA and rank. If your transcript is submitted prior to high school graduation or completion of final semester at another college, send your final transcript when complete.
If a graduate student, copies of your official transcripts, showing your last degree and any other graduate work attempted.
This Admission form.
$20 Application Fee for Undergraduate Students or $50 Application Fee for International Students.
Immunization records are required.
Please do not print this form and mail it in. Submit this application using the transmit button below.

Section I

I plan to enter East Central:

Summer
Fall
Spring

Year

What ECU Campus do you plan to attend?

Have you enrolled at ECU before?

Yes No (either on-campus or via distance education)

Under what name were you enrolled?

If yes, what year did you last attend?

Section II

Social Security No. (9 digits, no dashes) - -

Legal Name:

Last Name First Name Middle Name Jr/Sr Former Name(s)

Section III

Are you a citizen of the United States?

If you are not a citizen of the U.S.:

Country of Residence Country of Citizenship

Section IV

The information in this section is voluntary and requested for reporting purposes only in accordance with the 1968 Civil Rights Act as amended.

Are you Hispanic or Latino? Yes No

What is your Ethnicity? Check all that apply:

American Indian/Alaskan Native African American Asian

Hispanic or Latino Caucasian Native Hawaiian/Pacific Islander

Tribal Information if American Indian/Alaskan Native: Tribe Name Lineage

Section V

Residence Status:

Are you a resident of Oklahoma? Yes No

Have you lived continuously in Oklahoma for the past 12 months? Yes No

Date of Arrival in Oklahoma:

Your County of Residence

Out-of-state resident - Your State of Residence

Are you a military veteran? Yes No

Are you or your spouse on active duty? Yes No

Section VI

Gender: Male Female

Date of Birth: Month: Date: Year (four digits): Place of Birth (City, State):

Section VII

Classification:

Section VIII

Educational Objectives:

Do you hold a teaching certificate? Yes No

Are you working towards a degree? Yes No Do you plan to graduate from ECU? Yes No

Major field of study

Section IX

High School Information:

Name of last high school attended: City and State: Graduation date (year)

If you did not graduate, do you have a GED? Yes No Not Applicable

Have you taken the ACT or SAT? Yes No When? National Residual

International Students: Have you taken the TOEFL in the last 2 years? Yes No When? Score

Section X

Student Permanent Mailing Address: (No. P. O. Box for International Address, please)

Address: City: State: Zip: Phone: (000) 000-0000

Section XI

Student Local Address: (If different from Permanent Address)

Address: City: State: Zip: Phone: (000) 000-0000

Section XII

Student Local Address: List names and locations of ALL colleges and universities in which you have enrolled.

If you have ever attended ECU, including courses taught via Distance Education, list in this section also.
If you hold a bachelor's degree, list only your degree college and other colleges attended later.

Are you eligible to re-enter now, in good standing - without probation - all schools previously attended?

Yes No Not Applicable

Is your total college grade average C or above? Yes No Not Applicable

Name of college or university (List in Order of Attendance)	City and State	Dates of Attendance (mm/yyyy-mm/yyyy)	Sem Hrs Attempted	Degree Earned and Date of Graduate

(Failure to list institutions attended may result in loss of credit or dismissal.)

Section XIII

Have you ever, for reasons of conduct, been considered ineligible for enrollment at an educational institution? Yes No

Have you been convicted of, or pled guilty or no contest to a felony? Yes No

If you answered yes to either of these questions, please write a description of the circumstances (500 characters maximum):

Your e-mail address. This is necessary for us to send you further information.

Under Penalty of Perjury, I certify the above is true and correct.

I understand that my submission of this form will be considered a "signature".

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Last Updated: May 5, 2012

East Central University
Office of Admissions and Records
1100 E 14 PMB J8
Ada, OK 74820-6999
Phone: (580) 559-5234
Fax: (580) 559-5432