Admissions Form

If you have questions, please call the Records and Registration
Office at  (928) 428-8270, or (800) 678-3808, Ext. 8270.

First Name: Middle: Last Name:
Social Security Number*: 

*You may choose NOT to have your Social Security Number 
used as your EAC identification number.

I do not wish to provide the Easter Arizona College Records and 
Registration Office with my Social Security Number to be used as
my College ID number.

I understand that this choice may cause future difficulties in the 
transfer of my EAC credits to other institutions of higher education
and/or delays in locating my records.

I acknowledge that I have been notified of these potential 
difficulties and choose not to provide my Social Security Number.

Street Address or P.O. Box: Apt. No:
City: State: Zip:
Home Area Code & Phone: Work Area Code & Phone:

E-mail Address:
If we need to contact you between 8 a.m. and 5 p.m. on weekdays, do you 
prefer we use: home phone business phone e-mail
Birthdate:* -- mm/dd/yyyy Gender:*
Female   Male


Residency Determination:

Citizenship: U.S. Citizen  OR
  Visa type (specify type)  

Are you a legal Arizona resident?  Yes No 

If yes, date present stay in AZ began: -- mm/dd/yyyy

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


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
Personal Interest or Self-improvement


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


Primary Subject Area of Interest:
(Make choice from ONE of the four pull-down lists below)

Transfer Degrees
Associate of Arts Degree (AA - Transfer Degree) or
Associate of Business Degree (ABus - Transfer Degree) or
Associate in General Studies (AGS - Transfer Degree) or
Associate of Science Degree (AS - Transfer Degree)
Associate of Applied Science Degrees (AAS - Occupational Degree)
Certificates of Proficiency (Occupational)
Other Choices (Not Eligible for Financial Aid)


Race/Ethnic Background:*


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.


Optional Course Selection

Notice: If you know what courses you wish to take, you may use this form to 
register. If you need to check course offerings through the Online Class
Schedule, CLICK HERE
(Do not use your browser's back button, as 
doing so will clear all information already entered into this form
Student Information Forms are processed  during business hours and are 
subject to completion of prerequisites and receipt of complete data. Submission 
of this form does not guarantee class placement. For immediate registration 
assistance and confirmed registration
, please call (928) 428-8270 or
1-800-678-3808, Ext. 8270 to register by phone, non-holiday weekdays 
between 8 a.m. and 5 p.m.

Course selection for what semester or term (example: Spring 2000):

Course Title Dept. No. Section Credits Days Time


Payment Information: Visa  MasterCard

Card Number: Exp. Date: -- mm/yyyy
I authorize Eastern Arizona College to charge my Visa or 
MasterCard per the Tuition and Fees Schedule under the heading 
for the applicable academic year in the college catalog.

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 College Catalog for 
crime statistics
. Contact Campus Security Officeer Bill Mulleneaux at (928) 428-8240 for more information.