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EWC APPLICATION FOR ADMISSION

RETURN TO:

Type or Print all Information in Ink *You may not register or receive Financial Aid unless you have submitted an Application for Admission 1. Legal Name:

* No Application Fee Is Required

Last

First

Middle

2. Permanent Address:

Maiden or Former

Street/P.O. Box City

State

E-mail Address:

Zip

County

Cell Phone #

3. Residence Status:

Office of Admissions Eastern Wyoming College 3200 West C Street Torrington, WY 82240 307.532.8200 1.866.327.8996 ewc.wy.edu

State

Phone #

County

How long?

4. Current Address (if different from item 2): 5. Social Security Number:

Date of Birth

6. Who to contact in case of an emergency Address

City

State

)

Zip

Business Phone Number (

7. Country of Citizenship:

If not the U.S., what is your visa status?

“ Fall

10. Residency: “ In–State 11. Student will attend: 12. Classification:

“ Spring

“ Summer

“ Out–of–State

“ Full–Time (12+hrs)

“ First Time Freshman “ High School Student

Part–Time

Year 20

Secondary Major “ Associate of Science

15. Which campus location(s) will you be attending?

17. Intercollegiate Activities:

“ Interim

“ Transfer Student “ Previous EWC Student (dates attended)

14. What is your educational goal at EWC? “ Certificate “ Associate of Arts

“ on-campus

“ American Indian or Alaskan Native “ International/Foreign student

W.U.E. (The Western Undergraduate Exchange tuition rate is calculated at 1 1/2 times the resident tuition rate. To qualify, a student must be a resident of Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Utah, or Washington. Tuition rates will be calculated at 1 1/2 times the resident tuition rates for Nebraska residents.)

13. What is your primary major at EWC?

16. Living :

County

)

8. Ethnic Origin (This information is voluntary and will not be used in a discriminatory manner.) “ Black, non–Hispanic origin “ Hispanic “ Asian or Pacific Islander “ White, non–Hispanic origin 9. Term:

(M)

Relationship: (e.g. Parent, Guardian, Spouse)

Street/P.O. Box

Home Phone Number (

Sex (F)

“ off-campus

“ Undecided

“ Associate of Applied Science

“ Non-Degree Seeking

(Torrington, Chugwater, Glendo, Douglas, Glenrock, Guernsey, Hulett, Lusk, Moorcroft, Newcastle, Sundance, Upton, Wheatland)

“ with parents

“ Men’s Basketball

“ Volleyball

“ Golf

“ Rodeo

18. List last high school and ALL colleges attended. Send official transcripts from EACH college attended and from LAST high school attended, or GED scores if applicable. (Required for some scholarships.) “ Home Schooled: HIGH SCHOOL INFORMATION “ State Certification? “ High School Diploma Date Received? Name “ GED “ Neither mo./yr. Location (City/State) COLLEGES AND UNIVERSITIES ATTENDED

Name of Institution

Location

19. Are you interested in Federal Financial Aid and Eastern Wyoming College scholarships?

Dates of attendance (From mo. & yr. to mo. & yr.)

“ Yes

“ No

Degree received

Major

If so, please visit Financial Aid on ewc.wy.edu

20. Have you ever been convicted of, made a plea of guilty to, or accepted a deferred prosecution or judgement to, a felony, or have been required to register as a sex offender? “ Yes “ No If yes, attach an explanation. Are you currently incarcerated? “ Yes “ No 21. Hometown Newspaper Name

City

State

Zip

I declare under the penalty of perjury that the information furnished is, to the best of my knowledge and belief, correct and complete. Applicant’s Signature

Date


EWC HOUSING APPLICATION wA

$100 housing security deposit MUST accompany your application for housing, and will be refunded only if written notice of cancellation is provided to the Housing Office before August 1st for the Fall Semester and December 15th for the Spring Semester. Make remittance to: Eastern Wyoming College. Housing security deposits should be made early to ensure room reservation. w Admission by the college does not guarantee that on-campus housing accomodations will be available. Housing assignments are made based on date of deposit, activity scholarship status and demonstrated ability to share living quarters. wSemester charges include a meal plan of 17 meals per week (3 meals per day on weekdays and 1 meal a day on the weekend) and local phone service and internet service. Room and Board rates, as approved by the Board of Trustees, are published in the current college catalog. w The Housing Office makes reasonable accomodations for students with disabilities. Explain any needs that you have in this regard on a separate sheet and attach to this application.

Name

Male “ Female “

Social Security Number

ASSIGNMENT DATE OF DEPOSIT

Request a Room for Term: Fall “ Spring “ Year

Age

Date of Birth

E-mail Address

Emergency Contact

Relationship

Emergency Contact Phone # ( Permanent Home Address

) Street/P.O. Box

Business Phone # ( City

State

)

Home Phone # (

Zip

)

All on-campus housing facilities are smoke-free. Preferences below are for assignment purposes only. YES

Check (T) appropriate responses to items noted

NO

NO PREFERENCE

N/A

Do you smoke? Do you mind if your roommate smokes?

N/A

Do you drink? Do you mind if your roommate drinks?

N/A

Do you use chewing tobacco? Do you mind if your roommate uses chewing tobacco? I am neat.

N/A

I am messy.

N/A

I prefer a roommate who is neat. I prefer a roommate who is messy. Room Type Preference:

(Rank 1-2, 1 being top preference)

Standard Double Room

Suite

Roommate requests are granted when space is available, the request is mutual, and both requests are received on or about the same date. Roommate Request:

(Must be marked on each application)

Proposed Major:

Church Preference

Special Interests or Hobbies:

Sports:

Other information you would like us to consider: Student’s Signature

Date

Parent’s Signature

Date

NOTE: HOUSING IS RESERVED FOR FULL–TIME (12 HOURS) STUDENTS ONLY. EWC DOES NOT PROVIDE MARRIED STUDENT HOUSING.


Admission