Faculty & Staff Resources
Web E-Mail
Site Map

Application for Admission

Crowder College Student Self Identification Report
We consider all applicants for admission without discrimination based on race, color, religion, sex, national origin, age, veteran/reserve/national guard or any other similarly protected status.
To assist Crowder College in its effort to comply with federal and state requirements regarding government record keeping, reporting and other legal obligations, we invite you to supply the following information. Providing this information is strictly voluntary. Failure to provide it will not sublect you to any adverse decision or action or denied admission to Crowder College. Your cooperation is appreciated.
Please be advised that this report is not a part of your official student application. The information will be kept separate from your other application materials and used for the above reported purpose only and kept confidential in accordance with applicable laws and regulations.
Name Title First Last Suffix
Birth date
Employment status while attending college Full time Part time
Are you ( please check all that apply below) First Generation
Parents did not complete a 4 year college degree; or an individual who resided primarily with only one parent and that parent did not have a 4 year degree Single Parent Home
A person parenting at least one child, without a spouse or significant other Displace Homemaker
Has primarily been a homemaker without outside income, or has lost eligibility for public assistance Migrant
Student or parents have worked in agricultural/farming for 75 day within the past 2 years
All Information Provided Above Is Strictly Voluntary
Application Procedure
To be admitted each student must submit a completed Crowder College Application for Admission and a $25 application fee.

Enrollment in classes is subject to receipt of transcripts and your academic status. Please refer to the online catalog or visit the admissions office at Crowder College.

If you need special accommodations, please contact the Dean of Student Services, 417-455-5636
Degree & Certificates Offered by Crowder College
Associate of Arts degree - These degrees are designed to transfer to a four-year college or university for the completion of a baccalaureate degree in the arts and science.

Associate of Science degree - These degrees have specifically tailored general education components for the student pursuing a degree in a science related field.

Associate of Applied Science degree - The AAS degree allows students to focus their study to a specific field, and is not designed to transfer to a four-year school, although some programs and classes do transfer, depending on the institution.

Certificates - The certificate programs provide skills training and are generally completed in one year or less.

Other Programs- Selected programs which are post-secondary in nature and lead directly college credit or clock hours
OFFICIAL APPLICATION
First Semester Enrolled * Fall Spring Summer
The school year is divided into three segments called semesters: Fall, Spring and Summer.
Year of Enrollment *

Type in the year you plan to be attending Crowder College.
I. PERSONAL INFORMATION
To be completed by all students
First Name
Middle Name
Last Name
Former Name if Any First Last
If you have had another name you used such as a maiden name please supply that here.
Social Security Number - no dashes - *

Please supply us with your Social Security number.
Birth Date *

Please put in the Month then the Day and the Year separated by dashes like so 4/19/1983
Gender Both Female Ignore Male No gender given trans-gender
Marital Status * Married Single Divorced Widowed
Email

If you have an email address please let us know.
Mailing Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Please let us know your mailing address.
Permanent Mailing Address
Street Address

Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

If you may be moving or are just temporarily at your mailing address please also provide us with a permanent mailing address. A good example of a permanent mailing address would be your parents house.
How long have you lived at your permanent legal residence? *

Please supply the number of years/months you have lived at your permanent legal residence.
How long did you live at your former legal residence? *

Please supply the number of years/months you lived at your former legal residence.
Home Phone - (###) - ### ####
Cell Phone - (###) - ### ####
County in which you reside *
School District in which you pay property taxes
Have you ever been convicted of a felony, misdemeanor or other crime? If yes, explain *
Race: (Optional) Hispanic / Latino White Black / African American Asian American American Indian / Alaska Native Hawaiian Native / Pacific Islander
Citizenship * U.S. Permanent Resident Alien Other
If you specified 'Other' under Citizenship above please explain:

Use this only if you specified "Other" under Citizenship above.
Native Language * English Spanish Other
If you specified 'Other' above please list your native language here:

If your native language is not English or Spanish, please let us know what it is here.
Student Status * FT First time student at any college since completing high school, including Crowder Dual Credit or Tech Prep FR Former student at Crowder College TR Transfer Student(prior credit at another institution but first time at Crowder College) TS Transient Student (non-degree seeking at Crowder; taking one or more classes to transfer to another institution)
Student Classification * HS High School Student-Dual Credit FR Freshman (0-30 hours) SO Sophomore (31-60 hours) PJ Post Junior College (65+ hours) PB Post Baccalaureate SP Special (no GED or High School Diploma-6 hr cumulative maximum)
HIGH SCHOOL / G.E.D. INFORMATION
Your High School or GED Graduation Date / MM / DD YYYY
MM= Month, DD=Day, YYYY = Year
Choose your High School, GED, Home School, Non-Graduate or Other *

Please select your High School - if your school is not present please select 'other' from the list then continue.
If you chose 'Other' under High School, Name of School:
Name of High School, City, State
Did you attend or participate in the Missouri A+ Schools Program? Yes No
The "A School" program was established in 1993 by state law. http://dese.mo.gov/divimprove/aplus/proginfo/abtaplus.html
COLLEGE INFORMATION
List all colleges and/or universities which you have attended. Official transcripts of all degree-seeking students are required to be on file by the fourth week of the semester.

If you are transferring in credit hours obtained at other Colleges/Universities you need to list them here.
Name of College, City, State, Year(s)
Example College, Neosho, MO
Please list all your higher education here along with the name of the facility, city, state and year(s) attended. Skip a line for new entries.
Have you been a member of the armed forces? - Information is used only to provide you with additional information on transfer of military credits Yes, I have been a member of the armed forces. No, I have not.
Are you in good disciplinary standing at your former institution and can you return without restrictions? Yes No
Are you in good academic standing at your former institution? Yes No
PROGRAM OF STUDY
Please choose one

At the top of this form you will see definitions for degrees and certifications.
Associate of Arts Degrees

Please consult the student catalog for descriptions and details of these degrees. Additionally our helpful staff of councilors can help you decide which degree is right for you.
Associates of Applied Science
Associates of Science
Certificates

Certificates traditionally complete in less time then a full two year associates degree. Please consult the College Catalog and discuss your options with a councilor.
Other
III. EMERGENCY INFORMATION
Person to Contact in case of Emergency First Last
Emergency Contact - (###) - ### ####
Physicians Name First Last
Physician's Phone Number - (###) - ### ####
Hospital you wish to be transported to in case of emergency:
1. In case of an emergency, I authorize college personnel in charge to use their discretion regarding the college's emergency procedures. I understand that falsification of any information provided on this application will subject me to disciplinary action, which may result in my dismissal from the college.

2. I certify that the answers given in this application are complete and accurate to the best of my knowledge, and I understand that submission of false information may result in my denial or suspension.
*

Please type in your name, this counts as your legal signature!
Date * / MM / DD YYYY
IV. REMINDER AND INFORMATION
To assist in processing your application promptly, be sure to mail or fax all necessary documentation (official copies of your academic records, test scores) to:

Admissions Office Crowder College 601 Laclede Neosho MO 64850

Or fax records to 417-455-5663

The $25 application fee is also due at this time. You may mail a check, made payable to Crowder College, to the address above.
Your application will be held until receipt of all documents is complete. Materials become the property of Crowder College and cannot be forwarded elsewhere. In the abscense of a written signature, if you agree to the above terms, please select the SUBMIT button.
Please choose a security question below: * What is your favorite movie? What is your favorite flavor of ice cream? What is your favorite sports team?
Answer to your security question: *
Multiple Choice First option Second option Third option

Admissions

Financial Aid

Application for Admission

Application for Admission

Crowder College Student Self Identification Report We consider all applicants for admission without discrimination based on race, color, religion, sex, national origin, age, veteran/reserve/national guard or any other similarly protected status.

All Information Provided Above Is Strictly Voluntary

OFFICIAL APPLICATION

I. PERSONAL INFORMATION To be completed by all students

HIGH SCHOOL / G.E.D. INFORMATION

COLLEGE INFORMATION List all colleges and/or universities which you have attended. Official transcripts of all degree-seeking students are required to be on file by the fourth week of the semester.

PROGRAM OF STUDY Please choose one

III. EMERGENCY INFORMATION

Crowder College Student Self Identification Report
We consider all applicants for admission without discrimination based on race, color, religion, sex, national origin, age, veteran/reserve/national guard or any other similarly protected status.

I. PERSONAL INFORMATION
To be completed by all students

COLLEGE INFORMATION
List all colleges and/or universities which you have attended. Official transcripts of all degree-seeking students are required to be on file by the fourth week of the semester.

PROGRAM OF STUDY
Please choose one