Personal Data:

Identifying Information:

Social Security Number:
Birthdate: mm/dd/yyyy

Contact Information:

Proof of residency in the East Central College district may be required.


Cell Phone:
Alternate Phone:
Public school district in which you reside:

Are you a Veteran or are you currently serving in the U.S. Armed Forces?
Legal Sex:
Are you Hispanic/Latino?
Race: (choose one or more)
Are you a U.S. citizen?
Are you a permanent resident of the U.S.?
Visa type:
Please send a copy of your Alien Registration Card OR copies of your visa, passport and I-94 form to
Is English your first language?

Country of birth:
Country of citizenship:

Emergency Contact Information:



Best Contact Number:
Please state relationship:

Tuberculosis Questionnaire:

All new students intending to seek admission into East Central College must be screened for Tuberculosis (TB).
Please read the following set of questions:
Were you born, or have you lived, outside of the United States for more than two months?
Have you ever been in contact with someone who has, or had, TB?
Have you ever been diagnosed with TB?

ACCESS and Disability Services:

Access Services provides support for students who have documented disabilities by making reasonable accommodations in regard to academic instruction and other college related activities.

Students enrolling at East Central College who are seeking services for a disability must submit appropriate documentation and meet with an Access Counselor in order to receive services.

After submitting this form; Please complete the Access Application form available on:

Criminal Background:

Have you plead guilty to or been convicted of a felony?
Please report any and all states that this applies to:


When do you plan to begin classes or return to ECC?

Have you previously enrolled in credit courses at ECC?
Did you graduate from your high school/home school?
When did you graduate?
Name of school:
Are you still attending high school/home school?
When do you plan to graduate?
Name of school:
Did you pass the GED/HSE test?
What year did you pass the test?
Where did you take the test:
Have you previously enrolled in any college credit coursework, whether it was in high school or at another institution? (i.e. Dual Credit, Dual Technical Credit, Associates Degree, etc.)
College Name: (Do not Abbreviate)
Degrees Earned
From (Month/Year)
College Name: (Do not Abbreviate)
Degrees Earned
College Name: (Do not Abbreviate)
Degrees Earned
*Send additional sheets to if necessary
Are you currently on academic suspension from any college/university?
Please specify the date:
Have you ever been disciplined at a college or university?
Please explain:

Admissions Classification:


What academic program do you intend to study at ECC?
At which ECC location do you plan to take the majority of your classes?
Select the one that best describes you:

Financial Aid and Scholarship Information:

Are you currently involved in any clubs, sports or activities?
Please list:
Are you currently meeting the requirements for the Missouri A+ Scholarship Program?
Did either of your parents or step-parents attend ECC??
What was his/her name when he/she attended?
Priority deadline for scholarship consideration is December 1. Submit current high school transcript or GED/HSE scores and Free Application for Federal Student Aid (FAFSA) results by December 1.