Step 1 of 5 - Student Information 0% Student InformationLegal Name* First Last Preferred Name* First Last Marital Status* Single Married Divorced Widow/Widower Separated Single: Never Married Previously Married Maiden NameSex* Male Female Date of Birth* Month Day Year Are you over 18 y/o? Yes (Over 18) No (Under 18) Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*OK to text?* Yes No This field is hidden when viewing the formHome PhoneThis field is hidden when viewing the formWork PhoneThis field is hidden when viewing the formPreferred Phone Number Select All Cell Home Work Email* Best Way to Contact Call Text Email Facebook Messenger Citizenship* USA SSNEthnic Background American Indian or Alaskan Native White Black or African American Hispanic or Latino (all races) Native Hawaiian or Other Pacific Islander Asian TribeHave you ever been arrested for, charged with, or convicted of criminal conduct, a misdemeanor or a felony***may effect licensure/credentialing None Misdemeanor Felony Are you seeking financial assistance through any State or Federal Agency?* Workforce Oklahoma Vocational Rehab VA DHS Native American Tribe Other None Current Employer InformationHave you ever been employed?* Yes No Are You Currently Employed?* Yes No Employer Name*Employer Phone Number*Position*Start Date* MM slash DD slash YYYY End Date MM slash DD slash YYYY Educational BackgroundEducation Level*Select Education LevelStill in High SchoolDid not graduateHigh School DiplomaGEDSome CollegeCollegeName Of High School*Graduation Date / Date GED Recieved*Fill month and day to the best of your knowledge - Year is important Month Day Year List All other Colleges, Vocational or Technical Schools*Include whether or not you graduated - Write none if this is not applicableHave you ever been enrolled at Community Care, Clary Sage or Oklahoma Technical College?* Yes No Getting to know You1) What career are you interested in today?*UndecidedBarberCosmetologyEstheticianFashion DesignInterior DesignMakeup Artistry | CosmeticianMassage TherapyNail TechnicianMaster InstructorInterested in an Associates of Occupational Science Degree? Yes No 2) How soon would you like to start classes?* ASAP 1-2 Months 2-6 Months 6+ Months 3) What three questions are you hoping to get answered by your admissions representative?*4) Where have you seen us?*Click all that apply. Facebook Advertisement Facebook Post Instagram YouTube Google Search Website Advertisement TV Radio Newspaper Billboard Friend Family Airport Advertisement Bus Advertisement High School Career Fair Recruiter/Speaker If referred, who can we thank?Which radio station?Thank you for expressing interest in our College! In an effort to get to know you better please answer the following questions. A minimum of 3 complete sentences on EACH of the following 4 questions is required in order to be considered for enrollment.1) Where do you see yourself in 3 years? What goals will your education at this college help you achieve?*2) What led you to choose this field and this college?*3) Tell us about your current situation.*4) Our goal is to turn every student into a graduate! What challenges might stand in your way of becoming a successful graduate? What can you do to overcome these challenges in order to be successful? (Ex: Transportation, Bus fare, Family, Finances, Educational challenges)*Emergency Contacts2 Emergency Contacts are required. Almost there, one more page!Emergency Contact 1* First Last RelationPhone*Email* Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Emergency Contact 2* First Last Relation*Phone*Email* Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code I certify the information is true to the best of my knowledge and belief and I understand that I subject myself to disciplinary action in the event that the application facts are found to be falsifiedSignature*Signature of Parent or Guardian
