For

Either a nonrefundable $65 (U.S.) fee office

or a fee-waiver form must accompany this application use
only
Make check payable to University of Oregon and put student’s name and birth
Paid by Check date on check.
VISA MasterCard Exp. date CVC (three digits) PD
2019-2020 APPLICATION FOR ADMISSION
Credit card number
NF
Signature of cardholder
Name (exactly as it appears on card) FD

Please use blue or black ink. Mark boxes with an X.

1. Legal name
Last (family name) First Middle
Preferred first name
2. Other names that may appear on your academic records
Last (family name)
3. Social security number – – Please read the UO Social Security Number Statement on page 7.
4. Application for (one only) Fall (September) Winter (January) Spring (March) Summer (June)
Year Year Year Year
5. Intended major Professional objective
6. 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#
7. 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)

8. Mailing address
Number and street or P.O. box

- -
City State or Province ZIP Home telephone (include area code)

- -
County Nation Other telephone (include area code): Cell Work

9. Permanent address
Number and street or P.O. box

State or Province
- -
City ZIP Home telephone (include area code)

- -
County Nation Other telephone (include area code): Cell Work
10. E-mail address Yours Other
11. Gender (optional) Date of birth - -
Month Day Year

12. 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 2.
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 Pacific Islander White Racial or ethnic subgroup
13. Citizenship classification (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
14. Tuition equity 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
2787. You can read more about this opportunity by going to admissions.uoregon.edu/te. 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 2787) and am willing to submit the appropriate paperwork to support this status.
Yes No

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 Name Date of birth

15. 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 five required
subject areas you have completed through the end of your junior year (see page 5). 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 (AP/IB), or college credits (CC).
Check the term system used by the high school you attend(ed): ______ Semester ______ Quarter ______ Trimester ______ Block

One year or unit is equal to: High School College * Contact your school
counselor to determine how
Four quarters Three trimesters* One term (semester or quarter)
to convert your school’s block
Two semesters One block or two blocks* or trimester system into full-
year equivalents

Senior year schedule and totals

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

Grades nine through eleven totals

Subject RG HN AP/IB CC Total

Through the end of your junior
year in high school, how many
years of college preparatory
EXAMPLE: English 2 1 3
courses (as defined on page 5) did English
you complete in each of the five Math
subject areas with a grade of C - Science
or better?
Social Studies
Algebra I and geometry taken in Second Language
the eighth grade are acceptable.
Visual, Fine, or Performing Arts
Second language taken in the How many years of American Sign Language
eighth grade is acceptable. second language were in: French
We will add this information to German
your senior schedule to determine
Spanish
your total units completed.
Native American language
(please list)

Other language
(please list)

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 Name Date of birth

16. Academic information Request official transcripts showing courses through at least your junior year. Send final transcripts after graduation.
Attach an explanation if your record has been affected by unusual circumstances.
Name of high school City State
HS CEEB Code Date of graduation Month
– Day
– Year
Rank in a class of If precise rank is not available, indicate rank to nearest decile (first decile is top 10 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
Month Day Year
17. Test scores Report the highest score on a single test date for each of the tests you took. See page 4 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
18. 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
from to or will receive

Courses in progress College, location Total credits

Courses planned Term College, location Total credits

Transfer Applicants TRANSFER APPLICANTS MUST ANSWER THE QUESTIONS BELOW

19. 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 4 for details. Determine if your course is college level at admissions.uoregon.edu/collegelevel.
Writing
Course number and title College Term Year
Math
Course number and title College Term Year
Second language
Course number and title College Term Year
High school graduation year High school attended

If you graduated from high school spring 1997 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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 Name Date of birth

20. Personal Statement/Essay (500 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 4 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 documentation may be required to substantiate residency
If you are a nonresident of Oregon or you are going to apply for Tuition Equity under HB 2787, 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 classified as an Oregon resident, for tuition purposes, regardless of your
state residence. For more information, visit admissions.uoregon.edu/tribalmembers.
23. Tuition Classification
Yes No

Yes No
Yes No
/
Yes No
If Yes, what was your graduation or completion year? _____________

Student Information
Dates of military service, if applicable (mm/yy) 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 12 months? Yes No
Are you younger than 24 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 classified as a nonresident.

Parent or Guardian Information

This information is for my Mother Father Guardian
Legal state of residence of my parent or guardian is
Has the parent or guardian listed above resided in Oregon for consecutive months? Yes No
If Yes, when did their most recent continuous presence in Oregon begin? (mm/yy) /
Dates of military service, if applicable (mm/yy) from / to /
Did you enter the military service as a resident of Oregon?* Yes No

* Note: If you were discharged from military service, you must send us a copy of the DD-214
form. 4
 Name Date of birth

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

5
 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

Last (family name) First Middle

Number and street City State or Province ZIP

- - - -
Home telephone (include area code) Other telephone (include area code): Cell Work

E-mail address

Relationship: Mother Father Legal guardian Spouse Domestic partner Other

Last (family name) First Middle

Number and street City State or Province ZIP

- - - -
Home telephone (include area code) Other telephone (include area code): Cell Work

E-mail address

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 officially report on students on our campus in regards to ethnicity and race, some students find the official
question to not be a good fit for how they define themselves. This question, while not used in our official reporting, provides these students with a chance to
say more about themselves, and for 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 offered 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 multiracial/multiethnic?
Yes No

Certification 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 support 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

6
Social Security Number Disclosure and Consent Statement
To comply with the Tax Payer Relief Act of 1997, the University of Oregon must obtain your The University of Oregon affirms and actively promotes the right of all individuals to equal
correct social security number (SSN) to file returns with the Internal Revenue Service (IRS) opportunity in education and employment at this institution without regard to race, color,
and to furnish a statement to you. The returns filed by the UO must contain information sex, national origin, age, religion, marital status, disability, veteran status, sexual orienta-
about qualified tuition and related expenses. The Privacy Act of 1974, section 6109 of the In- tion, gender identity, gender expression, or any other extraneous consideration not direct-
ternal Revenue Code, requires that you give your correct SSN to agencies that must file infor- ly and substantively related to effective performance. This policy implements all applicable
mation returns with the IRS. The IRS uses your SSN for identification and to verify the accuracy federal, state, and local laws, regulations, and executive orders. Direct related inquiries to
of your tax return. For more information, please refer to Internal Revenue Code section 6050S. the Office of Affirmative Action and Equal Opportunity, 474 Oregon Hall, University of
By signing the application, you give your permission for the use of your SSN to assist the UO Oregon, Eugene OR 97403-5221; 541-346-3123. This publication will be made available in
and the OUS (and organizations conducting studies for or on behalf of the OUS) in develop- accessible formats upon request. ©2016 University of Oregon MCXXXXX-205oy
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 identification 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 identified above.
This request is made pursuant to Oregon Revised Statutes 351.070 and 351.085. 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, benefit, or privilege provided by law. You may revoke your consent for Office of Admissions 541-346-3201
the use of your SSN at any time by writing to the Office of Admissions. If you do not give con- 1217 University of Oregon 800-BE-A-DUCK
sent to use your SSN for research, please attach a note requesting a system-generated number. Eugene OR 97403-1217 admissions.uoregon.edu

Apply online at admissions.uoregon.edu