WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
2011 APPLICATION PACKET
WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
NURSING APPLICATION PACKET
The Nursing Department at Western Oklahoma State College is looking forward to selecting another
successful nursing class to begin fall 2011. We are excited about the entrance of this class. We currently
have campuses at Altus, Elk City, and Lawton. Classes are taught via ITV with instructors in the
classrooms at each campus.
Applicants will need to indicate on the application which campus they prefer to attend. Students willing to
travel to campus sites other than the one located in their area will need to indicate their choice by priority
such as first, second, etc.
Applications for the program must be turned in to the Nursing office at any of our three (3)
campuses or be mailed to the Altus Campus (see address below) by May 15, 2011. Please review the
following curriculum pre-requisites. Other general education courses required before graduation are
listed on the enclosed Curriculum Plan. Students are selected on a point system basis. This includes
points given for pre-nursing test scores, cumulative GPA, completion of required general education
courses and for the grades received in those courses. Please note that more point value is given for
completion of science courses and the grades received in those courses. Pre-requisites may be taken
during the summer 2011 semester as long as courses are completed and grades are turned in to the nursing
department office before fall 2011 classes begin. Classes taken after May 15 will not be counted for
points in the application process.
CONTACT INFORMATION AND MAILING ADDRESS:
Western Oklahoma State College
Department of Nursing Education
2801 North Main Street
Altus, Oklahoma 73521
Melissa Hurst 580-477-7830
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
GENERAL STUDENTS
You MUST have the following pre-requisites completed, with appropriate transcripted grades, to enter the
program:
 Human Anatomy with a lab - (must have a grade of “C” or better)
 College Algebra
 General Chemistry with a lab - (must have a grade of “C” or better)
TRANSFER STUDENTS
Procedures for Transfer Student entry to the program varies related to transferability of nursing course
credits, program accreditation, and correspondence with WOSC’s nursing program area of study per
semester. Please be certain to contact the nursing department prior to applying (580-477-7830).
LPN STUDENTS
Procedures for LPN entry to the program differ because of program accreditations, Cooperative
Agreements, etc. Each LPN applicant MUST contact the department at 580-477-7830 to have LPN
credits assessed for entry purposes, as additional mobility testing may be required. To receive
advance standing credit, LPN applicants must hold a valid LPN license and be in good standing and
currently practicing as an LPN. LPN students must have completed the following courses with
appropriate grades to be considered for selection:
 Human Anatomy with lab – (must have a grade of “C” or better)
 College Algebra
 General Chemistry with lab - (must have a grade of “C” or better)
 Human Physiology with lab - (must have a grade of “C” or better)
 Microcomputer Applications
 General Psychology
 LPN to RN Transition Course-This course is offered the summer before entry into NURS 2219
(This is mandatory and will be offered during the 2nd 4 week session of the summer semester)
HESI EXAM REQUIREMENT FOR PROGRAM COMPLETION
All students are required to take the HESI exam during their last semester in NURS 2229. All students
will take the test a total of three scheduled times as indicated in the syllabus and the initial cost is
included in the course fees. Western requires a score of 850 on the HESI exam. If a score of less than 850
is obtained, a remediation plan must be developed. This must be a written plan that is discussed with the
classroom instructor. Once remediation is complete, a student must re-take the HESI exam until his/her
score is equal to or greater than 850. The HESI exam can be taken up to one additional time. The cost for
the fourth additional test is the student’s responsibility and is NOT included in semester tuition.
If a score of 850 is not achieved, a student will receive an Incomplete in the course until it is achieved. If
a score of 850 cannot be achieved by the fourth exam, then the student will not successfully pass the
course or complete the nursing program. At this point, NURS 2229 must be retaken and successfully
completed.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
HIGH SCHOOL & COLLEGE TRANSCRIPTS
An official copy of high school transcript/GED AND college transcripts for each college attended
(including WOSC transcripts) must be submitted with the nursing application. Combined college
transcripts will not be accepted. A cumulative GPA of 2.0 out of a possible 4.0 is required. Applicants
with a cumulative GPA less than 2.0 are considered ineligible for acceptance into the nursing program.
Applications submitted without all transcripts will be incomplete and will not be considered for selection.
LPN students must also submit a copy of their LPN Program Transcript of Certificate of Completion
along with a copy of their current LPN license.
ESL – ENGLISH AS SECOND LANGUAGE
Students for whom English is a second language shall be required to present evidence of proficiency in
the English language prior to admission.
Per the 2010-2011 WOSC College Catalog page 18:
“Students seeking enrollment in a state system college or university must meet the
admission standards in the admission policy, the retention policy, and the policy on
admission of transfer students. This policy is adopted to ensure that students will have a
reasonable chance to succeed at a higher education institution based on their ability to
comprehend, read, and write the English language.”
DRUG SCREEN
Applicants accepted into the nursing program will undergo a random drug screen prior to entry into the
enrolled course. Licensed practical/vocational nurses with positive drug screens are reported to their state
of licensure per state board nursing rules.
AFFIRMATIVE ACTION COMPLIANCE STATEMENT
Western Oklahoma State College, in compliance with Title VI and Title VII of the Civil Rights Acts of
1964, Title IX of the Education Amendments of 1972, Section 503 of the Rehabilitation Act of
1973Section 402 of the Readjustment Assistance Act of 1974, and other federal laws and regulations,
does not discriminate on the basis of race, color, national origin, sex, age, religion, handicap, or status as
veteran in any of its policies, practices or procedures. This includes, but is not limited to admissions
employment, financial aid, and educational services.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
INTERNATIONAL STUDENTS
Applicants classified as an international student using an F-1 Student Visa may attend at one of Western’s
campuses. However, all initial processing & paperwork must be completed with the Office of
Registrar at the Altus campus. Oklahoma law only allows a license to be issued to U.S. citizens, U.S.
nationals, and legal permanent resident aliens. Other qualified aliens may be issued a temporary license
that is valid until the expiration of their visa status, or if there is no expiration date, for one year. For
more information regarding this matter, applicants can contact the Oklahoma Board of Nursing.
STATEMENT CONCERNING THE AMERICAN WITH DISABILITY ACT
According to the ADA (Americans with Disabilities Act), each student with a disability is responsible for
notifying the College of his/her disability and requesting accommodations. If you think you have a
qualified disability and need classroom accommodations, contact the Counseling Office (C-1E). To
receive services, you must submit appropriate documentation and complete an intake process during
which the existence of a qualified disability is verified and reasonable accommodations are identified.
Please call (580) 477-7710, or email april.dill@wosc.edu for more information.
Please advise the instructor of your disability as soon as possible to ensure timely implementation of
appropriate accommodations. Faculty have an obligation to respond when they receive official notice of a
disability from the Counseling Office but are under no obligation to provide retroactive accommodations.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
CRIMINAL BACKGROUND INFORMATION
ALL STUDENTS (GENERAL, LPN, AND TRANSFER STUDENTS) MUST OBTAIN THE
FOLLOWING:
1. CRIMINAL HISTORY BACKGROUND CHECK from Oklahoma State Bureau of Investigation (OSBI).
The original copy must accompany the application packet. Faxed copies will not be accepted.
The college does not deny an applicant entry into the nursing program due to a positive criminal history.
However, various clinical agencies have restrictions regarding individuals with a criminal record.
Criminal background information is reviewed and decisions are made based on the clinical agency’s
policies and guidelines. If an applicant does not meet the standards set by the Oklahoma Board of Nursing
or the clinical agencies, the applicant will not be able to complete the requirements of the program.
According to the Oklahoma Board of Nursing:
“An individual with a felony conviction or who had sentencing terms imposed by the court
related to a deferred sentence for a felony offense cannot apply for licensure for at least five
years after completion of all sentencing terms, including probation and suspended sentences,
unless a presidential or gubernatorial pardon is reviewed [59 O.S. § 567.5 & 567.6].”
OSBI CRIMINAL HISTORY CHECKS:
Background checks can be requested/received by mail or in person. DO
history check by fax. FAXED REPORTS WILL NOT BE ACCEPTED.
NOT
request background
STEPS TO OBTAINING AN OSBI CRIMINAL HISTORY CHECKS
1. REQUEST BY MAIL
Complete the “Criminal History Information Request Form” off the OSBI website –
http://www.ok.gov/osbi/criminal_history
When completing the form, for “Type of Search Requested” the following must be
chosen/selected:
 Name Based - $15.00
 Sex Offender - $2.00
 Mary Rippy Violent Offender - $2.00
Mail completed form, acceptable method of payment and pre-paid self-addressed envelope to:
Criminal History Record Information Request
6600 North Harvey Place
Oklahoma City, OK 73116
Acceptable methods of payment by mail include money orders, Visa, MasterCard, Discover,
cashier’s check or certified check. No personal checks are accepted.
Requests are processed and returned in 1 to 3 weeks from the date they are received.
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
2. OSBI REQUEST IN PERSON –
You may obtain a Criminal History Record Check in person by going to the OSBI office located at
following address:
Broadway Executive Office Park
6600 North Harvey, Building 6, Suite 140,
Oklahoma City, OK 73116.
Same form must be completed and same fees apply.
ADMISSION ASSESSMENT EXAM
In January 2010, the WOSC Department of Nursing decided to use a new entrance exam: Evolve Reach
Admission Assessment Exam. As a result of this change no TEAS exam scores will be accepted for
admission. The Evolve Reach Admission Assessment Exam covers five (5) academic areas: Mathematics,
Reading, Biology, Anatomy and Physiology.
All applicants will be required to take a pre-entrance nursing exam. This exam will be given on several
dates and various times in April and May at all campuses. It may be possible to make arrangements to
test at additional testing sites. Exam dates, times and campuses where the exam will be given are
included in this packet. The cost of the exam is $30.00 if paid by April 21, 2011. Exam fees will increase
to $35.00 on April 25, 2011. All exam fees must be paid at the WOSC Business Office. Students may
pay for the exam in person, by credit card or by mailing payments. The “Admission Exam form” must be
presented to the cashier at the time of payment.
A copy of the paid receipt must be given to Melissa Hurst in the Nursing Department office before the
exam will be scheduled, NO exam will be scheduled without a receipt. Computers are limited therefore
exams will be scheduled on an availability basis.
Exam General Rules:
 Applicants may retest ONE (1) time per application period.
 Applicants must present a current photo ID prior to start of exam
 BASIC calculators only will be allowed during exam, no programmable calculators will be
allowed. No calculators will be provided.
 No food, drinks, or cell phones are allowed while taking the exam.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
PAYMENT
IN PERSON
 Payments can be made in person at the WOSC Business Office at Altus. Provide cashier with
completed “Admission Exam form”. Bring paid receipt to Melissa Hurst in the Department of
Nursing Office. Exam appointment can be scheduled at this time.
BY CREDIT CARD
 When making credit card payment – contact the WOSC Business office at 580-477-7730. You
will need to provide them with: exam account number (90112), your social security number
and your telephone number. Please ask that they put a copy of the payment receipt in the
Nursing Department mailbox. Contact Melissa Hurst at 580-477-7830 to schedule date for exam.
You will need to wait a couple of days after making payment before scheduling an exam date. Do
not call the same day to make your appointment.
BY MAIL
 Applicants can mail payment for exam. Make checks payable to Western Oklahoma State College
and mail to:
Western Oklahoma State College
Department of Nursing Education
2801 N. Main Street
Altus, OK 73521
 Mail completed Admission Exam Form along with check. Please contact Melissa Hurst at 580477-7830 to confirm payment received and schedule exam appointment.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
2011 NURSING APPLICATION
ADMISSION EXAM FORM
Account # 90112
Provide WOSC Business Office with complete form when making payment.
Today’s Date: __________________________
Name: __________________________________
(Please Print)
SSN: __________ - __________ - ____________
Mailing Address: ____________________________________________
____________________________________________
City
State
Zip Code
Phone Number: _______________________________
THE COST OF THE EXAM:

$30.00 IF PAID BY APRIL 15, 2011

$35.00 IF PAID AFTER APRIL 18, 2011 through APRIL 21, 2011

NO PAYMENTS WILL BE ACCEPTED AFTER APRIL 25, 2011
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
ADMISSION EXAM SCHEDULE
SPRING 2011
DATE
April 4, 2011
April 6, 2011
April 8, 2011
April 12, 2011
April 14, 2011
April 19, 2011
April 20, 2011
April 26, 2011
April 28, 2011
May 2, 2011
May 4, 2011
May 6, 2011
DAY
Monday
Wednesday
Friday
Tuesday
Thursday
Tuesday
Wednesday
Tuesday
Thursday
Monday
Wednesday
Friday
TIME
9:00am-2:00pm
9:00am-2:00pm
12:00pm-5:00pm
9:00am-2:00pm
9:00am-2:00pm
9:00am-2:00pm
9:00am-2:00pm
9:00am-2:00pm
9:00am-2:00pm
2:00pm-7:00pm
9:00am-2:00pm
9:00am-2:00pm
SITES
Altus and Lawton
Altus, Lawton and Elk City
Altus and Elk City
Altus, Lawton and Elk City
Altus and Lawton
Altus, Lawton and Elk City
Altus, Lawton and Elk City
Altus, Lawton and Elk City
Altus and Lawton
Altus and Lawton
Altus, Lawton and Elk City
Altus and Elk City
**APPLICANTS:



Please allow 5 hours to complete exam.
Arrive 10 minutes prior to start of exam to complete necessary paperwork.
If NOT present at start of exam, applicants will have to reschedule exam.
STUDY GUIDE
A study guide can be purchased at the WOSC Bookstore Altus Campus or on-line at various
websites (Overstock.com, Amazon.com) or at the following website:
www.us.elsevierhealth.com
Enter ISBN#: 9781416056355 in search field
Estimated cost of the study guide is $36.95 plus shipping and handling.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
APPLICANT CHECKLIST
THIS IS FOR THE APPLICANTS INFORMATION ONLY
DO NOT TURN IN WITH APPLICATION
________ OFFICIAL HIGH SCHOOL TRANSCRIPT/GED ATTACHED
________ OFFICIAL COLLEGE TRANSCRIPT(S) ATTACHED FROM ALL COLLEGES
ATTENDED
________ OSBI BACKGROUND CHECK ATTACHED
________ CERTIFIED COURT DOCUMENT(S) RELATED TO CONVICTIONS/CHARGES
(If applicable)
________ LPN TRANSCRIPT ATTACHED (Please make sure you have contacted the Nursing
Department regarding your LPN program’s accreditation status prior to submitting
application)
________ COPY OF LPN LICENSE ATTACHED
CURRICULUM COMPLETED
**General Students must have completed pre-requisite courses and transcripts turned into the nursing office by
August 1, 2011.
LPN’s must have all shaded courses completed before August 1, 2011, and copy of transcript (s) turned into the
nursing office by August, 1, 2011.
COURSE
COURSE NAME
**BIOL 2104
BIOL 2304
**CHEM 1115
**MATH 1513
COSC 1153
PSY 1113
Human Anatomy with lab
Human Physiology with lab
General Chemistry with lab
College Algebra
Microcomputer Applications
General Psychology
NURS 1123
LPN to RN Transition
Course*
ENGL 1113
POLS 1113
HIST 1483/93
English Comp I
Federal Government
American History
________ APPLICATION TURNED IN
________ TEST DATE SCHEDULED
________ ADMISSION TEST TIME & DATE: _______________________________________
________ TEST PAID FOR
________ RECEIPT TURNED IN TO WOSC DEPT. OF NURSING OFFICE AT ALTUS.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
2011 APPLICATION FOR
ADMISSION TO THE ASSOCIATE DEGREE NURSING PROGRAM
TODAY’S DATE _____________________ SOCIAL SECURITY NUMBER ______________
(Month, Day, Year)
NAME: ______________________________________________________________________
(Last)
(First)
(Middle)
(Maiden)
PHONE: _____________________________________________________________________
(Home)
(Cell)
(Work)
EMAIL ADDRESS: ____________________________________________________________
MAILING ADDRESS: __________________________________________________________
(Street)
____________________________________________________________________________
(City)
(State)
(Zip)
(County)
PERMANENT ADDRESS: ______________________________________________________
(Street)
____________________________________________________________________________
(City)
(State)
(Zip)
(County)
EMERGENCY CONTACT: ______________________________________________________
(Name)
(Phone)
____________________________________________________________________________
(City)
2011 Application Packet
(State)
(Zip)
Page 12
WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
ARE YOU A U.S. CITIZEN? _____ YES_____ NO
IF NON-CITIZEN (Please mark the appropriate status)
_____ F-1 Student Visa _____ Permanent Resident
_____ Other immigrant status
ARE YOU AN LPN / LVN _____ YES _____ NO
(If yes, attach PN school transcript or certificate of completion)
LPN SCHOOL ATTENDED
CITY, STATE
YEAR GRADUATED
IF YOU ATTENDED ONE OF THE FOLLOWING TECHNOLOGY CENTERS DID YOU SIGN A
COOPERATIVE AGREEMENT WITH WESTERN OKLAHOMA STATE COLLEGE BEFORE
GRADUATING? ___YES___ NO
_____ GREAT PLAINS TECHNOLOGY CENTER
_____ RED RIVER TECHNOLOGY CENTER
_____ SOUTHWEST TECHNOLOGY CENTER
_____ WESTERN TECHNOLOGY CENTER
HAVE YOU PREVIOUSLY ATTENDED AN RN NURSING PROGRAM___YES ___ NO
IF YES, LIST SCHOOL ATTENDED:
____________________________________________________________________________
School
City, State
Year last semester was successfully completed
REASON FOR LEAVING: ______________________________________________________
____________________________________________________________________________
____________________________________________________________________________
*HAVE YOU EVER BEEN CONVICTED, ENTERED A PLEA OF GUILTY, NO CONTEST, OR A
SIMILAR PLEA, OR HAD PROSECUTION OR A SENTENCE DEFERRED OR SUSPENDED
AS AN ADULT OR JUVENILE IN ANY STATE OR JURISDICTION?
*ANSWER TO QUESTION IS VOLUNTARY
______YES ______NO
*HAVE YOU EVER BEEN CONVICTED OF OR HAVE PENDING INVESTIGATION
REGARDING THE COMMISION OF A FELONY?
______YES ______NO
*ANSWER TO QUESTION IS VOLUNTARY
If you answered yes to either question above, you must send certified copies of all court documents
related to your criminal history with your application.
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
According to the Oklahoma Board of Nursing “An individual with a felony conviction or who had
sentencing terms imposed by the court related to a deferred sentence for a felony offense cannot apply
for licensure for at least five years after completion of all sentencing terms, including probation and
suspended sentences, unless a presidential or gubernatorial pardon is reviewed [59 O.S. § 567.5 &
567.6].”
HIGH SCHOOL ATTENDED
____________________________________________________________________________
Name
YEAR GRADUATED
(CITY)
(STATE)
COLLEGES/UNIVERSITIES ATTENDED
COLLEGES / UNIVERSITIES
ATTENDED
(List in chronological order)
CITY / STATE
ATTENDED
FROM / TO
DEGREE
MAJOR
(ATTACH A PAGE FOR ADDITIONAL COLLEGE INFORMATION)
EMPLOYMENT HISTORY (PAST 5 YRS)
PLACE OF EMPLOYMENT
2011 Application Packet
CITY / STATE
POSITION
DATE STARTED
DATE ENDED
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
The Western Oklahoma Department of Nursing Education is approved by the Oklahoma Board of
Nursing. Graduates of this state-approved program are eligible to apply to write the National Council
Licensure Examination (NCLEX) for registered nurses. Applicants for Oklahoma license to practice
nursing. In addition to completing a state-approved nursing education program that meets educational
requirements and successfully passing the licensure examination, requirements include submission of an
application for licensure, a criminal history records search, and evidence of citizenship or qualified alien
status. To be granted a license, an applicant must have the legal right to be in the United States (United
States code chapter 8, section 1621). In addition, Oklahoma law only allows a license to be issued to U.S.
citizens, U.S. nationals, and legal permanent resident aliens. Other qualified aliens may be issued a
temporary license that is valid until the expiration of their visa status, or if there is no expiration date, for
one year. Applicants who are qualified aliens must present, in person, valid documentary evidence of:
1. A valid, unexpired immigrant or nonimmigrant visa status for admission into the United States;
2. A pending or approved application for asylum in the United States;
3. Admission into the United States in refugee status;
4. A pending or approved application for temporary protected status in the United States;
5. Approved deferred action status; or
6. A pending application for adjustment of status to legal permanent resident status or conditional
resident status.
The Board has the right to deny a license to an individual with a history of criminal background,
disciplinary action on another health-related license or certification, or judicial declaration of mental
incompetence [59 O.S. §567.5 & 567.6].
2011 Application Packet
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WESTERN OKLAHOMA STATE COLLEGE
DEPARTMENT OF NURSING EDUCATION
I,
HEREIN, MAKE APPLICATION FOR ADMISSION INTO THE
NURSING PROGRAM AT WESTERN OKLAHOMA STATE COLLEGE. I DECLARE MY
INTENTION TO ENROLL IN THE NURSING PROGRAM FOR THE FOLLOWING SEMESTER:
______ NURSING 1119
GENERAL STUDENTS/FALL SEMESTER
______NURSING 1129
LPN STUDENTS/ SPRING SEMESTER
_____NURSING 2219
LPN / TRANSFER STUDENTS
FALL SEMESTER
I UNDERSTAND THAT THE NURSING PROGRAM OF WESTERN OKLAHOMA STATE
COLLEGE ADMITS A LIMITED NUMBER OF STUDENTS DUE TO AVAILABLE RESOURCES
AND/OR FACULTY, AND ALTHOUGH I MAY MEET OR EXCEED THE MINIMUM
REQUIREMENTS FOR ADMISSION, CIRCUMSTANCES MAY PREVENT THE NURSING
PROGRAM FROM ADMITTING ALL STUDENTS WHO HAVE MET THE ADMISSION
CRITERIA.
I CERTIFY THAT THE INFORMATION IN THIS APPLICATION IS COMPLETE TO THE BEST
OF MY KNOWLEDGE.
ALL INFORMATION IN THIS APPLICATION IS CONFIDENTIAL AND WILL BE USED BY THE
NURSING ADMISSION COMMITTEE AND THE DIRECTOR OF NURSING ONLY.
I UNDERSTAND THAT SUBMISSION OF FALSE INFORMATION IS GROUNDS FOR DENIAL
OF ADMISSION TO OR DISMISSAL FROM THE WESTERN OKLAHOMA STATE COLLEGE
NURSING PROGRAM. I ALSO UNDERSTAND, IF MY APPLICATION PACKET IS NOT
COMPLETE, INCLUDING COPIES OF TRANSCRIPTS FROM EACH COLLEGE I HAVE
ATTENDED, THAT I WILL NOT BE CONSIDERED FOR ADMISSION IN TO THE PROGRAM.
PLEASE BE AWARE THAT DUE TO CURRENT ECONOMIC CRISIS & BUDGET
SHORTFALLS, THERE IS THE POSSIBILITY OF AN OFF-SITE CAMPUS CLOSING. IF A
CAMPUS CLOSING DOES OCCUR, APPLICANTS WILL BE NOTIFIED AND MAY BE
RELOCATED TO ANOTHER CAMPUS.
CAMPUS SITE PREFERRED: (PLEASE RANK CHOICE: 1ST, 2ND & 3RD)
ALTUS__________ ELK CITY________LAWTON________
APPLICANT’S SIGNATURE
2011 Application Packet
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