Distance Learning Student Information Form

Failure to fill out the entire form could delay your enrollment process

This form is used as a tool for demographic purposes. Information gathered will be used for reporting statistics to the Spears School of Business and Oklahoma State University.

No changes from last year.

Student Information

Name*

FirstLast

CWID*

Oklahoma State Email Address

Preferred Email Address

Education Information

Semester*

Spring
Fall
Summer

Year*

Student Classification

Certificate Program

Student Demographic*

On-campus (OSU-Stillwater)
On-campus (OSU-Tulsa)
Distance Learning (enrolled in ALL distance learning courses)
Other

Employment Information

Employer

Title

Work Address

Street AddressAddress Line 2CityStateZip Code

Work Phone

Work Fax

Military Information

If You Are Active Duty Military Please Check

Military Base

In order to receive our military rate you will need to send a copy of your active duty/duty history paperwork to cepd-dl@okstate.edu or fax to 405-744-1891.

Proctor Information

If you will be using an OSU on-campus testing center please provide the information below. If not, please submit the proctor agreement form located on the distance learning web site under "how to enroll."

Proctor Facility Name*

Wes Watkins Center ($12 charge to your Bursar Account)
OSU/Tulsa ($10 check or cash)
University Assessment and Testing ($15 charge to your Bursar Account)
OSU/OKC
Other (Proctor form required)

Wes Watkins Center
309 Wes Watkins Center
405-744-6390
osu.ics-inf@okstate.edu

Tulsa Testing Center
700 N Greenwood Ave North Hall 103
918-594-8232
tulsa.testing@okstate.edu

105 UAT Building
Stillwater, OK 74078
405-744-5958
testing.center@okstate.edu

OSU/OKC
Student Center, First Floor, Room 104
405-945-8648
testing@osuokc.edu

Download Proctor Agreement Form