2019-2020 APPLICATION FOR ADMISSION
Please use blue or black ink. Mark boxes with an X.
. Legal name
Preferred rst name
. Other names that may appear on your academic records
. Social security number – –
Please read the UO Social Security Number Statement on page 7.
. Application for (one only)
Fall (September) Winter (January) Spring (March) Summer (June)
. Intended major Professional objective
. Have you previously applied to or attended the UO? Yes No
If yes, date of last application: Term
Year Last term attended: Term Year UO ID
. Parent’s education level (optional) Highest level of education achieved by either of your parents. Middle school or junior high Some high school
High school diploma or GED Some college Associate’s degree Bachelor’s degree Other (specify)
. Mailing address
- -
- -
. Permanent address
- -
- -
. E-mail address Yours Other
. Gender (optional)
Date of birth - -
. Ethnicity and race To comply with federal statistical reporting requirements, the University of Oregon must seek to identify the racial and ethnic background of
applicants. You are encouraged to supply this information, but your application will be given the same consideration whether or not you do so. Please answer both the
Hispanic or Latino and race questions. For more information, see page .
Hispanic or Latino Are you Hispanic or Latino?
Yes No
What is your race? (check one or more
) American Indian or Alaska Native Asian Black or African American
Native Hawaiian or Other Pacic Islander White Racial or ethnic subgroup
. Citizenship classication (check one)
US citizen US
permanent resident; list alien registration number
Nonimmigrant student using F or J visa
Other; list your immigrant status while in US
If you are a US permanent resident, attach a copy of visa or front and back of US immigrant-status card
. Tuition equit
y If you are an undocumented student living in Oregon, you may qualify for an exemption from non-resident tuition and fees based upon House Bill
. You can read more about this opportunity by going to admissions.uoregon.edute. If you would like to be considered for in-state tuition based upon this law, answer
the question below. Please note that answering ‘Yes” does not automatically qualify you for this program.
I wish to be considered for a waiver of out-of-state tuition under the Oregon Tuition Equity bill (HB ) and am willing to submit the appropriate paperwork to support this status.
Yes No
Either a nonrefundable $65 (U.S.) fee
or a fee-waiver form must accompany this application
Paid by Check
VISA MasterCard Exp. date CVC (three digits)
Credit card number
Signature of cardholder
Name (exactly as it appears on card)
Make check payable to University of Oregon and put student’s name and birth
date on check.
PD
NF
FD
For
oce
use
only
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First Middle
Last (family name)
Last (family name)
Year Year Year Year
Month Day Year
Nation
State or Province
ZIP
Home telephone (include area code)
Other telephone (include area code):
Cell Work
City
City
County
County
Nation
State or Province
ZIP
Number and street or P.O. box
Number and street or P.O. box
Home telephone (include area code)
Other telephone (include area code):
Cell Work
Subject RG HN AP/IB CC Total
. HIGH SCHOOL SUBJECT REQUIREMENTS FRESHMEN ONLY
To make admission and scholarship decisions we need to know the college preparatory classes you will have completed by the time you graduate.
Many transcripts do not include a senior schedule. Therefore, list all senior courses below. Also indicate the total number of courses in our ve required
subjec
t areas you have completed through the end of your junior year (see page ). Indicating which courses are honors, AP, IB, or college credits will
help us identify the strength of your curriculum choices.
We need to know if you will have completed the equivalent of a full unit of each course requirement. There are a variety of term systems, we need
your help to identify if you will have the equivalent of a full year of each subject. One term of college course work is equivalent to one unit of high
school.
INSTRUCTIONS: Failure to complete this section will delay your admission decision. For your senior year, list the course titles and the units in a partic-
ular subject you will have completed by the time you graduate. For grades nine through eleven, enter the total units. Indicate courses as regular (RG),
honors (HN), Advanced Placement or International Baccalaureate (APIB), or college credits (CC).
Check the term system used by the high school you attend(ed): ______ Semester ______ Quarter ______ Trimester ______ Block
Name Date of birth
One year or unit is equal to: High School College
Four quarters Three trimesters* One term (semester or quarter)
Two semesters One block or two blocks*
* Contact your school
counselor to determine how
to convert your school’s block
or trimester system into full-
year equivalents
Senior year schedule and totals
Grades nine through eleven totals
EXAMPLE: English 2 1 3
English
Math
Science
Social Studies
Second Language
Visual, Fine, or Performing Arts
How many years of American Sign Language
second language were in:
French
German
Spanish
Native American language
(please list)
Other language
(please list)
Subject Course title(s) RG HN AP/IB CC Total for
year
EXAMPLE Literature, College Composition .5 1 1.5
English
Math
Science
Social Studies
Second Language
Visual, Fine, or
Performing Arts
Through the end of your junior
year in high school, how many
years o
f college preparatory
courses (as dened on page ) did
you complete in each of the five
subject areas with a grade of C -
or better?
Algebra I and geometry taken in
the eighth grade are acceptable.
Second language taken in the
eighth grade is acceptable.
We will add this information to
your senior schedule to determine
your total units completed.
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. Academic information Request ocial transcripts showing courses through at least your junior year. Send nal transcripts after graduation.
Attach an explanation if your record has been aected by unusual circumstances.
Name of high school City State
HS CEEB Code Date of graduation – –
Rank
in a class of If precise rank is not available, indicate rank to nearest decile (rst decile is top percent)
GPA
Cumulative through semester: six seven eight.
Is GPA based on weighted grades? Yes No If yes, attach a copy of your weighted grading policy.
GED students. Date you took or plan to take the GED examination – – Score
. Test scores Report the highest score on a single test date for each of the tests you took. See page for details.
SAT (old): Reading and Writing Mathematics Writing Date taken
SAT (new): Critical Reading
Mathematics Date taken
ACT: English
Mathematics Writing Composite Date taken
SAT Subject Test: Subject Score Subject Score Date taken
COLLEGE ATTENDENCE
REQUIRED FOR TRANSFER AND FRESHMEN APPLICANTS WITH CREDITS FROM A COLLEGE
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. Colleges attended List every college you have attended, are attending, or from which you will receive credit (including the UO). Failure to list all colleges
attended may result in denial of admission or disciplinary action. Send official transcripts from all schools other than the UO to the Office of Admissions. Attach a
separate sheet of paper to list more colleges. Indicate below whether you will earn an Associate of Arts Oregon Transfer (AAOT) or Associate of Science Oregon
Transfer in business (ASOT) degree from an Oregon community college or an Oregon Transfer Module (OTM) from any public two-year or four-year institution in
Oregon.
School Location (city, state)
Dates attended
Credits completed Degree received
or will receive
from to
Courses in progress College, location Total credits
Courses planned Term College, location Total credits
Name Date of birth
Transfer Applicants TRANSFER APPLICANTS MUST ANSWER THE QUESTIONS BELOW
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. College level course requirements List courses taken or planned that meet the published requirements. Official transcripts must be sent to the UO
for verification. See page for details. Determine if your course is college level at admissions.uoregon.educollegelevel.
Writing
Math
Second language
High school graduation year High school attended
If you graduated from high school spring or later, check all that apply:
I have completed two years of the same second language in high school. Specify language
I have completed two terms of the same second language in college. Specify language
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Course number and title College Term
Year
Course number and title College Term
Year
Course number and title College Term
Year
Month Day Year
Month Day Year
Name Date of birth
20. Personal StatementEssay ( words maximum) On an attached sheet tell us, in your own unique voice, something about you we cannot find elsewhere on
your application. We purposefully do not prescribe any one topic for the personal statement, because we want you to share what’s important to you. If you need some
direc-tion, though, a few topics you may consider include your future ambitions or goals, a significant experience that is integral to your personal identity, or a special
talent or unique interest that sets you apart from your peers.
21. Second Essay (optional) See page for details.
As you’ve looked into what it will be like to attend Oregon, you’ve hopefully learned about what makes Ducks unique. No two are alike, though, so tell us what makes
you who you are, and how that connects to our campus community. We are interested in your thoughts and experiences recognizing difference and supporting equity
and inclusion, and choosing one of these two options will guide you in sharing those thoughts. You can learn more about equity and inclusion at Oregon by visiting
inclusion.uoregon.edu
Choose one Essay Topic (250-500 words)
a. Describe an experience with discrimination, whether it was fighting against discrimination or recognizing your contribution to discriminating against a
person or group. What did you learn from the experience? In what ways will you bring those lessons to the University of Oregon?
OR
b. The University of Oregon values difference, and we take pride in our diverse community. Please explain how you will share your experiences, values and
interests with our community. In what ways can you imagine offering your support to others?
22. Special Circumstances Statement (if applicable) Include a statement of special circumstances that may have affected your academic performance (500-word
maximum) with your application describing any challenges you’ve overcome and explain their impact on your education. Details of any serious illness, diagnosed
disability, personal difficulties, or family circumstances that have affected your education are encouraged. Include your name and date of birth on each page.
Employees of Oregon higher education institutions are mandatory reporters of child abuse and neglect.
Residency FAILURE TO ANSWER ALL QUESTIONS WILL CAUSE YOU TO BE CLASSIFIED AS A NONRESIDENT
Additional document
ation may be required to substantiate residency
If you are a nonresident of Oregon or you are going to apply for Tuition Equity under HB , skip the residency section. If you are an enrolled member of a federally
recognized tribe of Oregon or a tribe with historical ties to Oregon you might be eligible to be classied as an Oregon resident, for tuition purposes, regardless of your
state residence. For more information, visit admissions.uoregon.edu/tribalmembers.
3. Tuition Classification
Yes No
Yes No
Yes No
For tuition purposes, do you consider yourself a resident of Oregon?
Are you a citizen, permanent resident of the US or have a specific visa that qualifies
you to be considered an Oregon resident for tuition purposes?
Have you resided in Oregon for twelve consecutive months?
If Yes, when did y
our most recent continuous presence in Oregon begin? (mmyy)
Did you earn your high school diploma or GED in Oregon? Yes No
If Yes, what was your graduation or completion year? _____________
Student Information
Dates of military service, if applicable (mmyy) from to
Did you enter the military service as a resident of Oregon?* Yes No
If you answer Yes to any of the three questions below, you must complete the parent or guardian information section.
Did a parent or legal guardian claim you as a dependent in the prior tax year? Yes No
Did a parent or legal guardian provide at least half of your support in the past months?
Yes No
Are you younger than years old at the time of this application?
Yes No
Note: If you are providing residency information for a parent or legal guardian, you must also provide contact information for that person. Failure to provide
parent or legal guardian contact information under Contact Information on page 14 will cause you to be classied as a nonresident.
Mother Father Guardian
Yes No
from to
Yes No
Parent or Guardian Information
infThis orma ftion oris my
Legal state of residence of my parent or guardian is
Has the parent or guardian listed above resided in Oregon for consecutive months?
If Yes, when did their most recent continuous presence in Oregon begin? (mmyy)
Dates of military service, if applicable (mmyy)
Did you enter the military service as a resident of Oregon?*
* Note: If you were discharged from military service, you must send us a copy of the DD-
form.
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24. Description of Accomplishments,
Activities
Instructions
• To get a better sense of your interests and co-curricular involvement, please share three significant activities you were involved with during
grades 9 -12. This may include special accomplishments, extracurricular activities, or any awards you have received. It might also include a job
you held, or formal programs meant to prepare you for college, such as Aspire, AVID, SEI, TRiO, Upward Bound, GEAR Up, or SAIL. For each,
provide a description of up to 200 characters to make sure we get a clear sense of how you were involved. In “role and impact,” discuss the
significance of your participation or recognition.
• We value the depth of your involvement in meaningful activities more than the quantity, so please only discuss one accomplishment in each of
the three sections; do not submit additional activity information.
• Please fully explain any acronyms you might use in this section. For example, even though you may have been in FBLA, please write out “Future
Business Leaders of America” for the sake of clarity.
Accomplishment or Activity One_______________________________________________ Dates: from ___________ to __________
Description Role and impact
Accomplishment or Activity Tw _______________________________________________ Dates: from ___________ to __________
Description Role and impact
Accomplishment or Activity Three_______________________________________________ Dates: from ___________ to __________
Description Role and impact
Name Date of birth
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26. Do you have potential eligibility for any services or benefits related to military or dependent status?
No
I currently serve in a branch of the United States armed forces
I am an eligible military dependent
I have previously served in a branch of the United States armed forces
27. English as a Second Language (ESL) and Multiracial Students
Recent state legislation in Oregon seeks to have us learn more about who is considering, and enrolling in, our state’s public universities as it relates to
language background, along with many other factors. Your answer will not be used in our admission decision.
Is English your first language? Yes No my first language is
While federal guidelines determine the way we ocially report on students on our campus in regards to ethnicity and race, some students nd the ocial
question to not be a good t for how they dene themselves. This question, while not used in our ocial reporting, provides these students with a chance to
say more about themselves, and f
or the UO to learn more about our student body in the process; students answering yes to this question will possibly receive
information on relevant student groups and services oered at Oregon. Your answer will not be used in our admission decision.
Regardless of how you answered our federal question regarding race and ethnicity, do you consider yourself to be multiracialmultiethnic?
Yes No
Certication APPLICATION MUST BE SIGNED FOR PROCESSING
• I certify that I have provided complete and accurate statements in this application. To the best of my knowledge, all official documents are authentic,
unaltered records that pertain to me.
• I understand that all official documents submitted in suppor
t of this application become property of the university and cannot be returned, copied, or
transferred to a third party.
• I understand that failure to list all colleges attended or falsification of official documents may result in denial of admission or disciplinary action.
• I have been informed that my application fee of is nonrefundable.
• I authorize the release of any information submitted by me in connection with the application to any person, firm, corporation, association, or government
agency, but only to verify or explain the information. If I am awarded a scholarship, I hereby give permission to the University of Oregon to issue a news release
listing my name, hometown, and the name and amount of the scholarship.
• By submitting this application, I am agreeing to notify the University of Oregon immediately should there be any changes to the information requested in this
application, including disciplinary history. Applicants should also be aware that the university regularly receives information about disciplinary and criminal
histories from concerned members of the community; verifiable information that contradicts the application information may be grounds for denial of
admission, or dismissal from the university.
Signature
Date
Name Date of birth
25. Contact Information List parents or legal guardians who know where you can be reached. Other relatives or friends may be listed.
Relationship: Mother Father Legal guardian Spouse Domestic partner Other
- - - -
Relationship: Mother Father Legal guardian Spouse Domestic partner Other
- - - -
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Number and street
City
State or Province ZIP
Number and street
City
State or Province ZIP
Home telephone (include area code)
Home telephone (include area code)
Last (family name)
Last (family name)
First
First
Middle
Middle
Other telephone (include area code):
Cell Work
Other telephone (include area code):
Cell Work
E-mail address
E-mail address
Social Security Number Disclosure and Consent Statement
To comply with the Tax Payer Relief Act of , the University of Oregon must obtain your
correct social security number (SSN) to le returns with the Internal Revenue Service (IRS)
and to furnish a statement to you. The returns led by the UO must contain information
about qualied tuition and related expenses. The Privacy Act of , section of the In-
ternal Revenue Code, requires that you give your correct SSN to agencies that must le infor-
mation returns with the IRS. The IRS uses your SSN for identication and to verify the accuracy
of your tax return. For more information, please refer to Internal Revenue Code section S.
By signing the application, you give your permission for the use of your SSN to assist the UO
and the OUS (and organizations conducting studies for or on behalf of the OUS) in develop-
ing, validating, or administering predictive tests and assessments; administering student aid
programs; improving instruction; identifying students internally; collecting student debts; or
comparing student educational experiences with subsequent work-force experiences. When
conducting studies, the UO and the OUS will disclose your SSN only in a manner that does
not permit personal identication of you by individuals other than representatives of the UO
and the OUS (or the organization conducting the study for the OUS) and only if the informa-
tion is destroyed when no longer needed for the purposes for which the study was conducted.
By providing your social security number, you are consenting to the uses identied above.
This request is made pursuant to Oregon Revised Statutes . and .. You are not
required to consent to the use of your SSN for research; if you choose not to do so, you will
not be denied any right, benet, or privilege provided by law. You may revoke your consent for
the use of your SSN at any time by writing to the Oce of Admissions. If you do not give con-
sent to use your SSN for research, please attach a note requesting a system-generated number.
Oce of Admissions
University of Oregon
Eugene OR
BEADUCK
admissions.uoregon.edu
The University of Oregon arms and actively promotes the right of all individuals to equal
opportunity in education and employment at this institution without regard to race, color,
sex, national origin, age, religion, marital status, disability, veteran status, sexual orienta-
tion, gender identity, gender expression, or any other extraneous consideration not direct-
ly and substantively related to eective performance. This policy implements all applicable
federal, state, and local laws, regulations, and executive orders. Direct related inquiries to
the Oce of Armative Action and Equal Opportunity, Oregon Hall, University of
Oregon, Eugene OR -; --. This publication will be made available in
accessible formats upon request. © University of Oregon MCXXXXX-oy
Apply online at admissions.uoregon.edu
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