Admissions Form Please print or type. If you have questions, please call the Records & Registration Office at (928) 428-8270, 1-800-678-3808 Ext. 8270, or Fax (928) 428-3729. Name: First Middle Last

Social Security Number:* *The Social Security Number is not used as the Student Identification Number. Students will have a unique Student Identification Number assigned. Students should be aware that a correct Social Security Number must be on file for reporting information pertaining to potential tax credits, and must be used by applicants for federal and state aid. Mailing Address: (P.O. Box or Street, Apartment) City State ZIP

I intend to enroll: Part-Time Full-Time E-mail Address: Fall 20 Spring 20 Summer 20 Telephone: Birthdate: ** (MM/DD/YYYY) Gender:** Home: Cell: Female Male Residency Determination: These questions are asked for the purpose of determining tuition and fees. State law now requires that a person who is not a citizen or legal resident of the United States or who is without lawful immigration status is not entitled to classification as an in-state student pursuant to A.R.S. Section 15-1802 or entitled to classification as a county resident pursuant to A.R.S. Section 15-1802.01. Students will be classified as out-of-state for tuition and fee purposes until proper documentation is provided to the Records and Registration Office. The responsibility of registering under the proper residency classification is placed upon the student. Any student who falsifies his/her residency may be subject to dismissal from the College and/or criminal action. Refer to the College catalog for residency guidelines. • Citizenship*: U.S. Citizen, or Visa type (specify type) Country • Are you a legal Arizona resident? Yes No If yes, date present stay in Arizona began. (Month/Day/Year) • Most recent state of legal residence prior to moving to Arizona: Month and year you left that state: • Arizona county of residence: Date you moved to this county: *Documentation is required. Submit proper documentation to the EAC Records and Registration Office. You can find a list of appropriate documenation at www.eac.edu/prop300. Education Status: (Check all that apply) High school graduate Name of school State Graduation month/year Expect to graduate from high school Name of school State Expected month/year of graduation Attended other college or university Name of last school attended Dates attended GED certified; Date GED obtained None of the above apply Reason for Enrollment: Employment reasons Transfer Personal interest or self-improvement Other Undecided Major Emphasis of Your Educational Program: Transfer Degrees: AA (Associate of Arts), or ABus (Associate of Business), or AS (Associate of Science), or AGS (Associate of General Studies) Occupational: AAS Degree (Associate of Applied Science Degree); or Certificate of Completion(Occupational) Other: Uncertain; or Not seeking a degree or certificate Primary Subject Area of Interest: (choose from list on back of this form) Race/Ethnic Background:** White American Indian or Alaska Native  Race or Ethnicity Unknown Black Asian Two or more races Hispanic of any race Native Hawaiian or Other Pacific Islander Non-resident Alien **Information you provide is voluntary and confidential and is used to comply with federal reporting requirements and has no effect on your enrollment status. 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 Registering for Classes: Three Ways to Register Online: Register over the Internet using Gila Hank Online, EAC’s real-time registration system. Go to www.eac.edu and click the Gila Hank Online link. From here, you can register for classes, print class schedules, check grades, and pay tuition. For assistance, call the Records and Registration Office at (928) 428-8270. Walk-in: Records and Registration Office, Student Services Building, weekdays 8:00 a.m. – 5:00 p.m. Operator-assisted phone-in: Weekdays between 8 a.m. and 5 p.m., (928) 428-8270 or (800) 678-3808, ext. 8270. To register for classes, you will need: • Your EAC ID Number. • To use Gila Hank Online (www.eac.edu), you need to sign in to your account using your EAC Student ID and your Monster ID provided by the Admis- sions or Records and Registration Office. If you did not receive your Monster ID, call (928) 428-8270. When logging in for the first time, use your Stu- dent ID as your password. You will be prompted to change your password. After your first visit, use your Monster ID and password for future login. • The section number for each class. • Your credit card number, expiration date, billing address ZIP code, and card ID, if paying with VISA, MasterCard, American Express, or Discover. EAC Curricula Select from the following list of EAC Curricula to answer the Primary Subject Area of Interest question on the reverse side of this Admissions Form.

Associate of Arts Degrees Associate of Applied Science Degrees Early Childhood Education ...... 30814 (AA - Transfer Degree) (AAS - Occupational Degree) Electrical and Instrumentation Technician . .30628 Administration of Justice**...... 60801 Advanced Manufacturing Technology. . 20615 Emergency Medical Anthropology...... 60802 Administration of Justice...... 20801 Technician - Certificate...... 30701 Art...... 60402 Administration of Justice-BAS Track. . 20804 Emergency Medical Technician - Communication Studies...... 60206 Administrative Professional** . . . . . 20114 Paramedic...... 30702 Early Childhood Education ...... 60808 Automotive Service Technology . . . . 20601 Fire Science - Level I*...... 30635 Education - Elementary...... 60201 Business**...... 20105 Fire Science - Level II* ...... 30625 Education - Secondary ...... 60202 Computer Assisted Design & Drafting Graphic Design...... 30402 English...... 60203 Technology...... 20603 HVAC-R...... 30643 Forestry...... 60703 Computer Information Specialist. . . . 20107 Law Enforcement**...... 30813 Health & Physical Education. . . . . 60501 Cosmetology...... 20111 Licensed Practical Nurse...... 30710 History...... 60803 Early Childhood Education ...... 20803 Media Communications...... 30401 Industrial Arts (see Technology) Early Childhood Education-BAS Track. 20805 Medical Assistant...... 30704 Languages...... 60205 Electrical and Instrumentation Medical Coding and Billing Liberal Studies...... 60000 Technology...... 20611 Specialist* ...... 31302 Music...... 60403 Environmental Technology ...... 20705 Medical Laboratory Assistant...... 30712 Political Science ...... 60804 Fire Science*...... 20610 Nursing Assistant...... 30706 Pre-Chiropractic Medicine...... 80705 General Technical Studies**. . . . . 20613 Patient Care Technician...... 30708 Pre-Medical Science...... 80707 Graphic Design...... 20401 Personal Computer Systems/Networking. .30119 Pre-Nursing...... 80708 Media Communications...... 20614 Personal Trainer ...... 30502 Pre-Pharmacy...... 60704 Nursing - RN and BSN Track Option. . 20702 Phlebotomist Technician...... 31301 Pre-Physical Therapy ...... 60705 Paramedicine...... 20703 Renewable Sustainable Energy Psychology ...... 60806 Personal Trainer ...... 20501 Certificate...... 30634 Sociology...... 60807 Small Business Management. . . . . 20115 Retail Management**...... 30123 Sports Studies...... 60502 Welding Technology ...... 20609 Small Business Proprietor...... 30118 Theatre Arts...... 60404 Sports Medicine and Rehabilitative Certificates of Proficiency Therapies...... 30501 Associate of Business Degrees Advanced Manufacturing and Design Welding/Manufacturing Fundamentals (ABus - Transfer Degree) Technician ...... 30639 Certificate...... 30642 Business Administration ...... 70101 Advanced Manufacturing Tecchnician . 30641 Welding Technology ...... 30626 Computer Information Systems. . . . 70102 Automotive Maintenance...... 30638 Automotive Service Consultant. . . . 30633 Other Choices Associate of General Studies Degree Automotive Technician...... 30605 (Not eligible for Financial Aid) (AGS - Transfer Degree) Bookkeeping**...... 30104 AGEC-A Certificate**...... 30000 General Studies**...... 50000 Business Office Assistant**...... 30116 AGEC-B Certificate...... 30001 Associate of Science Degree Business Technology Specialist**. . . 30121 AGEC-S Certificate...... 30002 (AS - Transfer Degree) Computer Assisted Design & Drafting Business Project Management Fundamentals Biological Science...... 80701 Technology - Level I...... 30618 Certificate...... 30130 Chemistry ...... 80702 Computer Assisted Design & Drafting Cosmetology Instructor Certificate . . . 30111 Engineering...... 80706 Technology - Level II ...... 30613 Personal Interest...... 10000 Geology...... 80703 Cosmetology Certificate ...... 30110 Updating Vocational Skills...... 19999 Mathematics ...... 81101 Cosmetology/Hairstylist Certificate. . . 30129 Physics ...... 80704 Cosmetology/Nail Technician Certificate. 30114 *Available in Gila County only / **Available on Pre-Optometry...... 80709 Database Support...... 30105 campus and online Wildlife Biology ...... 80710 Dental Assisting Specialist Certificate*. 31303

2019-2020 Tuition and Fees Tuition and Fees subject to change. General Tuition (per semester/term) *WUE (Western Undergraduate Exchange): Available to Credit Arizona Out-of-state *Students from full-time students from Alaska, California, Colorado, Guam, ‡ Hours Residents Non-resident WUE States Hawaii, Idaho, Montana, Nevada, New Mexico, North Dakota, Up to 1 $90 $380 - Northern Mariana Islands, Oregon, South Dakota, Utah, 2 $180 $760 - Washington, and Wyoming. Call 1-800-678-3808, ext. 8270 3 $270 $1,140 - for information. 4 $360 $1,520 - 5 $450 $1,900 - 6 $540 $2,280 - 7 $630 $2,660 - Other Registration Fees 8 $720 $3,040 - • Audit Fee—General Tuition plus $35 per credit hour 9 $810 $3,420 - • Non-Credit Course Fee—General Tuition plus $40 per 10 $900 $3,800 - credit hour 11 $990 $4,180 - • Web Course Out-of-State Fee—General Tuition plus $50 12 $1,080 $4,560 $1,620 per credit hour 13 $1,170 $4,940 $1,755 • See Class Listing for other class or lab fees 14 $1,260 $5,320 $1,890 15 & Over $1,350 $5,700 $2,025 Eastern Arizona College • Thatcher, Arizona ‡ Inclusive of General Tuition. 85552-0769 • (928) 428-8270 • www.eac.edu New Mexico Out-of-State Tuition Waiver available. Call 1-800-678-3808, ext. 8247 for information.

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. Approved for veterans benefits.

Eastern Arizona College complies with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act, 20 U.S. Code § 1092(f) and the Higher Education Opportunity Act of 2008 by distributing an Annual Security and Fire Safety Report. The report is intended to inform the campus community of campus safety information, Clery Act crime statistics, on-campus housing fire data and statistics, and policies and procedures relating to sexual violence, emergency response, and other safety factors. A copy of EAC’s Annual Security and Fire Safety Report can be found at http://www.eac.edu/About_EAC/Consumer_Information/report.pdf. Additional copies are available at the Alumni Library (Thatcher Campus), the Learning Resource Center (Payson Campus), and the library (Gila Pueblo Campus). A paper copy of the report will be provided upon request at EAC’s District Office, located at 615 N. Stadium Avenue, Thatcher, Arizona. A daily crime log listing all criminal and alleged criminal incidents reported to campus police/security is available on-site, during normal business hours, at each of the campuses: EAC Police Department, located at 620 N. College Avenue, Thatcher, Arizona (Thatcher Campus); Gila Pueblo Campus Administration Office, located at 8274 Six Shooter Canyon Road, Globe, Arizona (Gila Pueblo Campus); and Payson Campus Administration Office, located at 201 N. Mud Springs Rd., Payson, Arizona (Payson Campus).

A fire log containing all reported fires that occurred at any of EAC’s on-campus student housing facilities is available during normal business hours at the Housing Office, located at 900 N. College Avenue, Thatcher, Arizona.

MPR–KEM 10/30/19