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Oregon Extension Student Application
Thank you for your interest in the Oregon Extension. Please fill out the entire application. Questions about the application process can be emailed to
admissions@oregonextension.org
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First Name
Your answer
Last Name
Your answer
College from which you are applying (e.g University of Honolulu)
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender
Female
Male
Non-Binary
Other:
Clear selection
Academic Major
Your answer
Proposed Year of Graduation from college
2021
2022
2023
2024
2025
Other:
Clear selection
Year in college during the Fall you are at the OE
Sophmore
Junior
Senior
Other:
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College Mailing Address
Your answer
Email Address
Your answer
Cell Phone Number
Your answer
Home/Summer Mailing Address
Your answer
Which Fall semester are you applying for?
2018
2019
2020
2021
2022
2023
Other:
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Name of Parent or Guardian
Your answer
Mailing Address of Parent or Guardian
Your answer
Phone number of Parent or Guardian
Your answer
Name of the college professor who is writing your recommendation
Your answer
Email of the college professor who is writing your recommendation
Your answer
Do you have allergies, disabilities or conditions requiring medical attention that you think we should know about? If so explain here.
Your answer
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