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    Admission Application
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Personal Email AddressPlease use your own personal email address.
Confirm Personal Email Address
My Cell Phone Number
When are you planning to attend ECCC?
High School Graduation Year
Choose one.
NOTICE: Non-degree seeking students do not qualify for financial aid.Please be sure to choose the correct type above before proceeding.
Which pathway best describes your career interests?Â
Do you currently know what program of study you would like to declare?Â
Choose a program type.
Choose a program.
Choose a concentration.
If your planned concentration/major/program of study is not listed above, please provide below.
Click below to open a new window to view your free career inventory.
First NamePlease leave out apostrophes in names. Please use Mixed Case when typing your name.
Middle Name
Last Name
Suffix
Last Name at Birth
Preferred FIRST NameYou may leave this field blank if you prefer to be called by your first name.
GenderPlease choose your gender at birth.
Date of BirthMM/DD/YYYY
Will you be 21 before you begin taking college courses?
SSN
.
Ethnicity
 Race
 Are you a legal citizen of the United States?
Citizen Of
Visa
Tribal Affiliation
Are you or your parent or legal guardian a member of the military?Â
Legal Address
Legal Zip
Legal Address State
Legal Address City
Mailing Address
Mailing Zip
Mailing Address State
Mailing Address City
County
Country
Parent/Guardian Full Name
Parent/Guardian Cell Phone
Parent/Guardian Address
Zip
State
City
High School State
Last High School
High School City
Other High School Name
Have you taken any college level courses or dual credit courses at any other college other than East Central? If so, you must include all of those colleges below.
College 1
College 1 StateÂ
College 2
College 2 StateÂ
College 3
College 3 StateÂ
College 4
College 4 StateÂ
Would you like to add more colleges or colleges not listed?
College 1 Name
College 1 City
College 1 State
College 2 Name
College 2 City
College 2 State
College 3 Name
College 3 City
College 3 State
Check all that apply.
Check the box next to any organization, activity, or sport that interests you.
By typing your initials and date of birth below, you are agreeing that the information on this form is correct.
Initials
Date of Birth(MM/DD/YYYY)
By checking this box, you agree to receive text messages and emails from East Central regarding emergency alerts, grades, billing statements, and other information related to your account. Notifications will be sent to the cell phone listed on this application and emails will be sent to the personal email address listed on this application.
Entrance Year
Entrance Term
Year Term Description
Term Start
Term End
Pathway Description
Institutional Division Description
Degree Code
Grad Year Description
High School
College 1 Description
College 2 Description
College 3 Description
College 4 Description
Date Submitted
Concentration Code
Program Description
Program Code
Concentration Description
Dual Credit
Candidacy Type Description