Eagle Cap College Non-Admit High School Student Form Term you plan to take course(s): Summer 20__ /Fall 20__ /Winter 20__ /Spring__

Today’s Date______________

Personal Information Social Security Number _ _ _ - _ _ _ - _ _ _

Your Date of Birth ____ / _____ / _____ /(Month/Day/Year)

_____________________________________________________________________________________________ Last Name First Name Middle Name _____________________________________________________________________________________________ (Other Names Used)Last First Middle Gender: Male □ Female□

Are you a U.S Citizen: Yes□ No□ Permanent Resident: □ Foreign Exchange: □

_____________________________________________________________________________________________ Current Mailing Address City County/Province State (or Country) Zip _____________________________________________________________________________________________ Permanent Address City County/Province State (or Country) Zip _____________________________________________________________________________________________ Student’s Cell Phone Parent’s Phone _____________________________________________________________________________________________ Student’s Email Parent’s Email In compliance with the Department of Health and Welfare Eastern Oregon University must seek to identify the ethnic background of the student. Please check the appropriate box. □White, Non-Hispanic □American Indian or Alaska Native

□Asian or Pacific Islander □Black, Non-Hispanic

□Hispanic □Decline to Respond

Academic Information I am currently a high school

□Freshman

□Sophomore

□Junior

□Senior

Anticipated Graduation Date _______ / _______ Month/Year As a high school student you must receive special permission to take more than eight (8) credits per term with EOU. High school tuition for Eagle Cap College courses is $60 per credit hour plus the cost of textbooks. Both student and parent signatures are required to submit this form. Unsigned or incomplete forms will not be processed. This form must be submitted to EOU along with the revolving charge form and the consent to release information form. Signatures on this form obligate the parent/student to pay tuition costs. Contact the Registrar’s Office to request a transcript of courses completed at EOU. Student’s Signature: _______________________

Parent’s Signature: _______________________________