Admissions Form Getting started at EAC begins with Step 1: the Admissions Form. Submit it today to take the first step to an exciting future at EAC. Don’t want to wait? Call us today and complete this first step over the phone. Call the Records and Registration Office at (928) 428-8270 or (800) 678-3808, ext. 8270, during our regular business hours, Monday through Friday, 8 a.m. to 5 p.m., to be admitted immediately. The Records Office will give you your Monster and Student IDs so you can complete Step 2 and activate your Gila Hank Account, which will give you immediate access to register for classes and to access your Monster Mail account. First Name: Middle: Last Name: Social Security Number: The Social Security Number is not used as the Student Indentification Number. Students will have a unique Student Identification Number assigned. Students should be aware that a correct Social Security Number must be on file for reporting information pertaining to potential tax credits, and must be used by applicants for federal and state aid. Failure to provide a correct Social Security Number may diminish student's opportunities for federal tax credits Mailing Address or P.O. Box: Apt. No: City: State: Zip: Home Phone with Area Code: Cell Phone with Area Code: E-mail Address: Verify E-mail Address: If we need to contact you between 8 a.m. and 5 p.m. on weekdays, do you prefer we use your: home phone cell phone e-mail Birthdate:* -- mm/dd/yyyy Gender:* Female Male Residency Determination: These questions are asked for the purpose of determining tuition and fees. State law now requires that a person who is not a citizen or legal resident of the United States or who is without lawful immigration status is not entitled to classification as an in-state student pursuant to A.R.S. Section 15-1802 or entitled to classification as a county resident pursuant to A.R.S. Section 15-1802.01. Students will be classified as out-of-state for tuition and fee purposes until proper documentation is provided. The responsibility of registering under the proper residency classification is placed upon the student. Any student who falsifies his/her residency may be subject to dismissal from the College and/or criminal action. Refer to the College catalog for residency guidelines. Citizenship: U.S. Citizen OR Visa type (specify type) Country Are you a legal Arizona resident†? Yes No If yes, date present stay in AZ began: -- mm/dd/yyyy Most recent state of legal residence prior to moving to Arizona: Month and year you left that state: -- mm/yyyy Arizona county of residence: Date you moved to this county? -- mm/dd/yyyy † Proposition 300, passed by Arizona voters in November 2006, stipulates that college students who are not legal United States citizens or are without lawful immigration status must pay out-of-state tuition. Education Status: (Check all that apply) High School Graduate Name of school: State: Graduation: -- mm/yyyy Expect to graduate from high school Name of school: State: Expected Grad: -- mm/yyyy Attended other college or university Name of last school attended: From: -- mm/yyyy To: -- mm/yyyy GED certified Date obtained: -- mm/yyyy None of the above apply Reason for Enrollment: Employment Reasons Transfer Personal Interest or Self-improvement Other Undecided Major Emphasis of Your Educational Program: Transfer Degrees: AA (Associate of Arts), ABus (Associate of Business), AS (Associate of Science) or AGS (Associate of General Studies) Occupational: AAS Degree (Associate of Applied Science Degree) Certificate of Completion (Occupational) Other: Uncertain Not Seeking a Degree or Certification Race/Ethnic Background:* Specify Race/Ethnic Background American Indian or Alaske Native Asian or Pacific Islander Black Non-Hispanic Hispanic White Non-Hispanic Other Do you give permission for the College to release directory information relative to your enrollment (as per the Family Educational Rights and Privacy Act of 1974)? Yes No * Information you provide is voluntary and confidential and is used to comply with federal reporting requirements and has no effect on your enrollment status. Please click the submit button only once and wait for the form to be submitted. When your submission is successfully received, a confirmation page will be displayed. Eastern Arizona College welcomes qualified students without regard to sex, age, race, color, disability or national origin. EAC adheres to Title IX of the Educational Amendments of 1972. Eastern Arizona College is in full compliance with the Crime Awareness and Campus Security Act of 1990. See the "Security and Safety" section of the online College Catalog for crime statistics. Contact Campus Security Officeer Mike McEuen at (928) 428-8240 for more information.