APPLICATION FOR ADMISSION

Personal Data:

Identifying Information:

Social Security Number:
Confirm Social Security Number:
Birthdate:

Contact Information:

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

Personal Email:
(Do not use school email address)

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?
Gender assigned at birth:
Are you Hispanic/Latino?
Race: (choose one or more)
Select your citizenship status:
Visa type:
Please send a copy of your Alien Registration Card OR copies of your visa, passport and I-94 form to admissions@eastcentral.edu.
Is English your first language?

Country of birth:
Country of citizenship:

Emergency Contact Information:

Contact:

Address:

Best Contact Number:
Relationship:
Please state relationship:

Required Tuberculosis (TB) Screening Questions:

All new students intending to seek admission into East Central College must be screened for Tuberculosis (TB).
Please read the following set of questions:
  • Have you ever been diagnosed with TB?
  • Have you ever been in contact with someone who has, or had, TB?
  • Were you born outside the United States?
  • Have you engaged in frequent visits, prolonged visits, or military service outside the United States?
  • Have you been a volunteer or health care worker who served clients who are at an increased risk for active TB disease?

ECC will notify you if documentation of a PPD tuberculin test, chest X-ray, or IGRA test, within the past 12 months from a provider in the United States, is required. Documentation can come from your physician, county health department, or place of work.

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:
https://www.eastcentral.edu/access/application-form/

Criminal Background:

Do you have any pending felony charges, plead guilty to a felony, or been convicted of a felony?
Please report any and all states that this applies to:

Education:

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:
City/State:
Are you still attending high school/home school?
When do you plan to graduate?
Name of school:
City/State:
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.)
If you have registered for any courses at other colleges or universities for previous semesters (including dual credit / dual enrollment), please request that each college or university send us your official academic transcript (regardless of whether you completed courses or received grades). Failure to list all colleges is considered falsification of records and may void your admission.
College Name: (Do not Abbreviate)
City:
State:
Degrees Earned
From (Month/Year)
To
College Name: (Do not Abbreviate)
City:
State:
Degrees Earned
From
To
College Name: (Do not Abbreviate)
City:
State:
Degrees Earned
From
To
College Name: (Do not Abbreviate)
City:
State:
Degrees Earned
From
To
College Name: (Do not Abbreviate)
City:
State:
Degrees Earned
From
To
If you have additional colleges to list, please email the names and locations of those colleges to admissions@eastcentral.edu.

Admissions Classification:

Goals:

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:
Students who are not degree-seeking, certificate-seeking, or transfer are ineligible for federal financial aid.