OCCC Admissions Application

OREGON COAST
COMMUNITY COLLEGE

400 SE College Way
Newport, Oregon 97366

occc@oregoncoast.edu

www.oregoncoast.edu

541-867-8501
OCCC Admissions Application
Personal Information
Full Name*

First NameMiddle NameLast Name
Preferred Name
Birth Date*

MonthDayYear
E-mail*
example@example.com
Phone Number*
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County of Residence*

LincolnTillamookLaneBentonMarionUnknownNot ListedOut of State
Social Security Number - Providing your Social Security number (SSN) is voluntary. Please see the SSN acknowledgement statement.
Preferred Pronoun*

She/her/hersHe/him/hisThey/them/theirsZe, Zie, Xe/Hir, HirsPrefer not to answer
Oregon Resident?*

YesNo
Gender Identity (Optional: In terms of gender identity, how do you think of yourself?)

AgenderIdentity/Identities Not ListedGenderqueerManNon-Binary/Gender-Fluid or Non-ConformingNonePrefer Not to AnswerQuestioning or UnsureTrans ManTrans WomanTransgenderWoman
Are you Hispanic or Latino?*

YesNo
What is Your Race? (Check all that apply.)*

AsianBlack or African AmericanNative AmericanNative Hawaiian or Other Pacific IslanderWhiteRace and Ethnicity UnknownNot Specified
First-Generation Student? (First-generation means neither parent or legal guardian earned a bachelor’s degree.)*

YesNoPrefer Not to Answer
Sex at Birth*

FMXPrefer Not to Answer
Military Status: Helps the College know if you are a veteran or dependent of a veteran for determining benefit eligibility.*

Air ForceAir Force ReserveArmyAir National GuardArmy ReserveCoast GuardMarine CorpsNavyChild of Disabled VeteranSpouse of Disabled VeteranNot a Veteran or Dependent
Information About Your Academic Program

OCCC: Start Here, Go Anywhere!
Application Type:*

Continuing StudentNew Student (No previous OCCC classes)Early College (Lincoln County high school junior or senior)
Academic Program*

AccountingAquarium ScienceEarly CollegeEducationGeneral StudiesNon-Degree-Seeking Credit StudentNursing & Allied Health ProfessionsUniversity Transfer DegreeDual CreditIndustrial Technology & WeldingGED & English Language LearnerOther
What is Your Major?*

Aquarium Science CertificateAssociate of Applied Science - Aquarium ScienceEarly Childhood EducationESOLGEDAssociate of General StudiesDual CreditEarly CollegeWeldingNon-Degree-Seeking Credit StudentAssociate of Arts Oregon TransferAssociate of Science Oregon Transfer BusinessAcute Care Nursing Assistant CertificateAdvanced Emergency Medical Technician CertificateAssociate of Applied Science NursingMedical Assisting CertificateBachelor of Science NursingAssociate of Science Transfer in Computer ScienceAssociate of Arts Oregon Transfer in Elementary Education
Expected Start Term*

Winter Term: JanuarySpring Term: MarchSummer Term: JulyFall Term: September
Did You Graduate from High School/Obtain a GED?*

YesNo
Select Your High School*

Newport High SchoolTaft 7-12Toledo High SchoolSiletz Valley Charter SchoolEddyville Charter SchoolWaldport High SchoolHome-SchooledGEDNot Listed
Date Graduated High School*

MonthDayYear
Date
Notifications

Please review all acknowledgements and check each box. This is required before you can submit your application.
Social Security Number Acknowledgement
OCCC requests that you provide the College with your social security number (SSN) on a voluntary basis in accordance with ORS 341.290(17) for the purposes of accurate record keeping, required government program reporting, administration of financial aid programs, and college program evaluation purposes. Your SSN will not be used as your student ID number. By providing OCCC with your SSN, you authorize the college to share the SSN with the Oregon Higher Education Coordinating Commission (HECC) to satisfy state and federal education evaluation reporting. The HECC and OCCC may also use the SSN to match records for effective service and evaluation to the following organizations: The National Student Clearinghouse for the purpose of reporting enrollment and program completion so that student loans are properly administered; the Oregon Employment Department for purposes of conducting employment and wage research on students and graduates; the Oregon Department of Education for the purpose of providing aggregated information for use by local, state, and federal program evaluations and economic planning; the Oregon Department of Revenue for the purpose of collecting student debts if credit has been granted by OCCC; the Internal Revenue Service for the processing of 1098-T forms in support of you filing for federal educational tax credits. Provision of your Social Security Number and consent to its use is not required and 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 to the use of your Social Security Number at any time by contacting: Office of the Registrar, Oregon Coast Community College, Newport, OR 97366; 541-867-8538. You may submit your SSN to the OCCC Business Office on a separate form for the sole purpose of reporting your qualified educational expenses to the Internal Revenue Service on form 1098-T. You are required to provide your SSN for this specific use per tax code regulations.*

After reviewing please check here.
Application Affirmation Acknowledgement
I understand that withholding information requested on this application or giving false information may make me ineligible for admission to the College or subject to dismissal. With this in mind, I certify that the above statements are correct and complete.*

After reviewing please check here.
Student Communication Policy
OCCC will use electronic communication methods to conduct official and legal college business. Communication to OCCC students via electronic communication methods will speed the delivery of information. Every student and employee is given the appropriate account(s) to access these communications. Recipients are expected to read all electronic communications from the College sent to their College Email account(s). Students are also given an email account by OCCC and given the appropriate account(s) to access communications regarding those services OCCC provides for OCCC students. Recipients will be expected to read all electronic communication related to OCCC business and when necessary take action as a result of communications received from the College. It is expected that students will monitor their email account often to receive the most up-to-date information from the College.*

After reviewing please check here.
Statement of Non-Discrimination
The College prohibits unlawful discrimination based on race, color, religion, national origin, sex, marital status, disability, veteran status, age, sexual orientation, or any other status protected by federal, state, or local law in any area, activity or operation of the College. The College also prohibits retaliation against an individual for engaging in activity protected under this policy and interfering with rights or privileges granted under anti-discrimination laws. In addition, the College complies with applicable provisions of the Civil Rights Act of 1964 (as amended), related Executive Orders 11246 and 11375, Title IX of the Education Amendments Act of 1972, Section 504 of the Rehabilitation Act of 1973, Americans with Disabilities Act of 1990 (as amended), Uniformed Services Employment and Reemployment Rights Act (“USERRA’), and all local and state civil rights laws. Under this policy, equal opportunity for employment, admission, and participation in the College’s programs, services, and activities will be extended to all persons, and the College will promote equal opportunity and treatment through application of this policy and other College efforts designed for that purpose.

Persons having questions about equal opportunity and nondiscrimination should contact either the Vice President of Academic and Student Affairs or the Human Resources Director (see contact info below). The full policy can be found at: https://www.oregoncoastcc.org/equal-opportunity-non-discrimination

Bruce Clemetsen
Vice President of Academic and Student Affairs
400 SE College Way, Newport, OR 97366
541-867-8511
bruce.clemetsen@oregoncoast.edu

Joy Gutknecht
Director of Human Resources
400 SE College Way, Newport, OR 97366
541-867-8515
joy.gutknecht@oregoncoast.edu
Please affirm you have reviewed the Non-Discrimination statement, above.*

After reviewing please check here.
Student Rights and Responsibilities and Guidelines for Student Conduct Acknowledgment
Oregon Coast Community College is committed to honoring the rights of students and supporting a learning environment in which freedom to explore and express ideas is valued. The College holds students accountable for behavioral expectations that align with the College’s values and mission.It is the student’s responsibility to learn and meet the behavioral expectations of the College as outlined in the Student Rights and Responsibilities section of the College Catalog and in the Guidelines for Student Conduct, also outlined in the College Catalog. A student’s application for admission serves as acceptance of these expectations.*

After reviewing please check here.
FERPA Acknowledgement
The College abides by and honors all state and federal laws pertaining to the privacy and confidentiality of student directory information and student academic records as outlined in the College Catalog and on the College website.The Family Educational Rights and Privacy Act of 1974 (FERPA) grants students certain rights, privileges, and protections relative to individually identifiable student educational records that are maintained by the College. FERPA allows the College to disclose a student’s directory information without consent, unless the College has on file a request from the student to restrict the release of this information.*

After reviewing please check here.
Clery Disclosure Acknowledgement
The Crime Awareness and Campus Security Act of 1990 requires all colleges to distribute to students and employees current policies and procedures for campus security, reporting procedures, and a summary of criminal violations in previous years. The report applies to on-campus violations only. These reports are available from the Facility Manager and on our website. Oregon Coast Community College has an after-hours on-campus security officer present from 5:30pm to 9:30pm. If a major problem or incident should occur, the services of local law enforcement agencies will be utilized. Oregon Coast Community College encourages students to take personal responsibility for their own safety and for the safety of others. Students are urged to keep their cars locked, to keep track of their personal belongings at all times, to park in well lighted areas, and to walk to their parked cars with someone they know.*

After reviewing please check here.
Tuition & Fee Policy Acknowledgement
Tuition and fees are established by the OCCC Board of Education and are subject to change at any time. In-state tuition rates apply to residents of Oregon and of those states that share a border with Oregon: Washington, Idaho, California, and Nevada. Fees are due by Friday of the first week of the term. Late fees will be assessed on Monday of the second week of the term. Please see the College Catalog or schedule for more information.*

After reviewing please check here.
Please verify that you are human*
Should be Empty:

OCCC Admissions Application

Personal Information

Information About Your Academic Program

Notifications

Social Security Number Acknowledgement

Application Affirmation Acknowledgement

Student Communication Policy

Statement of Non-Discrimination

Student Rights and Responsibilities and Guidelines for Student Conduct Acknowledgment

FERPA Acknowledgement

Clery Disclosure Acknowledgement

Tuition & Fee Policy Acknowledgement