After completing this form, print a copy for your records then click on submit.


This application is for the term beginning
                      * Required Field

Biographic
* First Name * Middle Name
* Last Name * Social Security --
* Date of Birth
Social Security Number: we respect your right for privacy. State/Federal reports and Federal Financial Aid require the use of your SSN. Ozarka College will issue you a student ID number that will be used to reference your account.
 
Contact Information - Addresses
* Street Address
Address (cont.)
* Zip Code
* City * County
* State/Province
* Home Phone
like 501-450-5000
Email
Email Confirmation
 
If any of your records are under a different name, please provide complete name used:
First Name Middle Name
Last Name
 
Optional Information
Ethnic Group Gender
This information is requested for the completion of various federal and state reporting purposes. Ozarka College does not discriminate in admission of students on the basis on gender, disability, age, race, national origin, or religion as specified by TITLE IX of the Educational Ammendment of 1973.
 
Emergency Contact
First Name Last Name
Street Address
Address (cont.)
City County
State/Province
Zip Code Home Phone
Email
 
Military Service
Are you a veteran or presently in military service, or a dependent of a military service member?
No Yes
If any of your military records are under a different name, please provide complete name used:
First Name Middle Name
Last Name
 
Educational Goals
* Will you be seeking Financial Aid? Yes     No
* Enrollment Classification:
* I plan to attend:
* College Objective:
* Intended college major
Criminal Justice, Culinary Arts/Hospitality, Licensed Practical Nursing, Registered Nursing
all have additional admission requirements and instructions.
Please contact the admission office to request Details.
 
High School/GED
* Type of Degree
* High School Attended/Attending
* Year of Graduation/Completion
* City
* State
FICE CODE (Leave blank if unsure)
For GED, only enter the Year of completion and the state the GED was awarded in.
 
Educational Background
Please select the highest level of education for either parent or Guardian
Example: your mother has a 4 year degree and your father does not, please enter 4 year degree.

Are you currently enrolled in a college or university? Yes No
If yes, where?
Enter the total amount of hours accumulated:

List in chronological order all colleges and universities you have attended. Each applicant
for admission to the Ozarka College must have each college or university
attended send an official transcript of his/her work to the Office of Admissions,Ozarka College, 218 College Drive, Melbourne, Arkansas 72556
Name of Institution City State Entered
mm/dd/yy		 Departed
mm/dd/yy		 Degree Date
mm/dd/yy

Have you ever been suspended from another college or university? Yes No
If yes, where? when?
If "yes", please provide an explanation

I certify that the information contained in this application for admission is true and correct. I understand that misrepresentation or omission of information will be cause for dismissal and loss of credit. Should any of the information on this form change prior to my entry to the Ozarka College, I will immediately notify the Office of Admissions.

The following is needed before a student can be enrolled in the College:
  • Entering freshmen: a six- or seven- semester high school transcript upon application, a final transcript upon graduation, and the American College Test (ACT) scores or ASSET scores.
 
Selective Service Statement
I understand that to be eligible for admission to the Ozarka College in Melbourne, I must register, or exempt from registration, with the Selective Service System in accordance with the Military Selective Service Act, 50 U.S.C. Appx 451 et seq, as specified in Act 228 of the 1997 Acts of the Arkansas General Assembly.

I therefore swear or affirm under penalty of perjury that I have registered with the Selective
Service System, or I am exempt from such registration because of the following provision(s)
of the Military Selective Service Act or Act 228 of the Acts of the Arkansas General Assembly:
I certify that I am registered with the Selective Service
I certify that I am not required to register with the Selective Service because
I am female
I am a current member of the armed forces on active duty
I am under 18 years of age
I am 26 years of age or older
I am an exempted resident alien
Other, please specify below
Notes
To apply for admission to Ozarka College, the following credentials must be submitted:
  1. This electronic application or a formal application for admission.
  2. An official copy of a high school or GED (General Education Development) transcript indicating date of graduation and official transcripts of all colleges or universities attended.
  3. Proof of immunization against measles, mumps, and rubella.
  4. An official copy of the ACT, SAT, ASSET, or Compass results.
    (These are student assessments that are used for placement in math and English. Ozarka College is an open enrollment institution, however; certain programs may consider these scores as criteria for selection.)
I certify that the information contained in this application for admission is true and correct. I understand that misrepresentation or omission of information will be cause for dismissal and loss of credit. Should any of the information on this form change prior to my entry to Ozarka College, I will immediately notify the Admissions Office.

I hereby give permission to Ozarka College to use, in booklets, press releases and other promotions, the applicant's name and any school photograph or video or footage in which this applicant may appear. These images may appear in any of the wide variety of formats and media now available to the college and that may be available in the future, including but not limited to print, broadcast, videotape, CD-ROM and electronic/online media.

I authorize Ozarka College to access my immunization record through the Arkansas Department of Health and Human Services Immunization Register.

"Be it resolved: Ozarka College is an affirmative action/equal opportunity institution. In keeping with its non-discrimination policy in employment, admissions and other functions and programs, the College considers employees and students on the basis of individual merit without regard to sex, race or color, religion, national origin, age, condition of handicap, or other factors irrelevant to participation in its programs."

Information concerning completion or graduation rates of degree-seeking, full-time students entering Ozarka College, and Campus Security information is available on request from the VP of Students Services, (870) 368-2027.

Please mail supporting application documents to: Office of Admissions Ozarka College P.O. BOX 10 Melbourne, Arkansas 72556.



Please enter the text shown above.

218 College Drive Melbourne, AR 72556
Melbourne: (870) 368-7371 - (800) 821-4335
Ash Flat: (870) 994-7273 | Mt. View: (870) 269-5600
Fax - Administration: (870) 368-2091 | Fax - Finance: (870) 368-2092

Copyright © 1998 - 2007 Ozarka College unless other credit explicitly given
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