First Name

Middle Name

Last Name

Do you have any previous/former names?

Please list any other/prior names:

Date of Birth

Government Recognized Gender Marker

Social Security Number

Citizenship

Ethnicity

Race

Home Address Line 1

Home Address Line 2

City/Town

State

Zip/Postal Code

Email Address

Confirm Email Address

Mobile Phone

Do you wish to opt-in to text messaging?

Charter Oak offers text messaging to provide college-wide communications and updates. You may opt-out of text messages at any time by replying STOP or by submitting the Opt-In/Opt-Out form. Message frequency varies. Message and data rates may apply.

Privacy Policy    Terms of Use

Please Note: Text messaging has not yet gone live. Students will be notified when texting has gone live.

Home Phone (if different from Mobile)

Do you CURRENTLY attend High School?

Please select the year you are graduating High School:

What courses will you be taking at Charter Oak State College? 

Please review Registration Restrictions for Undergraduate Visiting Students and Graduate Visiting Students

Questions/Comments

If you wish to request accommodations for a disability, please contact The Office of Accessibility at oas@charteroak.edu or by phone at 860-515-3846. Please do so prior to the start of classes.

By submitting this form, I confirm that the information provided on this form is accurate and complete, and subject to all policies and procedures of Charter Oak State College (as described in the College Catalog, including the Student Code of Conduct) and the Connecticut Board of Regents.