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ELIGIBILITY VERIFICATION FORM
Required for Admission to an Online Program at Oregon Tech
What is your intended major? (If your intended major is not listed below, it is not offered as an online program, and you should not apply for admission as an online student.)
Allied Health MS
Applied Psychology BS
Clinical Sleep Health Certificate
Dental Hygiene BS
Diagnostic Medical Sonography BS
Health Care Management BS - Clinical
Health Care Management BS - Radiologic Science
Health Informatics BS
Information Technology BS
Magnetic Resonance Imaging Specialization
Operations Management BS
Polysomnographic Technology Certificate
Pre-Medical Imaging Technology
Radiologic Science BS
Respiratory Care BS
Sleep Health AAS - Clinical Sleep Health
Sleep Health AAS - Polysomnographic Technology
Technology and Management BAS
Vascular Technology BS
Please provide the following:
Full Legal Name
Date of Birth
Student ID Number (You may not have one.)
Where do you live? If you do not live in the United States, please select "other" from the bottom of the list.
District of Columbia
Other (I do not live in the United States.)
Which of the following describes you?
I am a U.S. citizen.
I am a U.S. permanent resident. (A copy of the front and back of your permanent resident card must be submitted to Oregon Tech.)
I am not a U.S. citizen or permanent resident.
How did you initially learn about our program? (Mark all that apply.)
Oregon Tech Website
Other Website (please specify)
Word of Mouth (please specify)
Other (please specify)
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