Mo 08:00-17:00; Tu 08:00-17:00; We 08:00-17:00; Th 08:00-17:00; Fr 08:00-17:00

what is your business address?

300 East College Avenue, Eureka, IL 61530, US

What do you know about my business?

Eureka College was founded by abolitionists from Kentucky who were members of a religious movement known as the Christian Church (Disciples of Christ) and were committed to providing young people a broad, liberal education. These pioneers believed in an education infused with values as a basis for leadership. Chartered by the Illinois Legislature in 1855, Eureka was the first college in the state and third in the nation to admit men and women on an equal basis. Eureka College was designated by the National Park Service as a Campus Historic District in the National Register of Historic Places in June 2010.

What is Unique about your business?

We're recognized as a top college in Illinois for vocations like teacher education, nursing, communications, and criminal justice, and we're adding new courses for emerging careers like early childhood and sports management. A Eureka College education prepares you for more than just your first job: it equips you to become a leader in your field and community.

Personal Data Document

Basic Information

First Name*

Last Name*

Email Address*

Primary Phone

How would you like to receive RAVE alerts?

The RAVE Broadcast System is used to notify all students, faculty, and staff of campus wide emergencies and notifications. This includes, but is not limited to campus closings, inclement weather, active shooter, campus wide announcements, and location changes for campus wide events. The RAVE system will send a text and/or email with information to all users. The information shared through the texts and emails will be brief and informative. All students are included in the RAVE system. For questions regarding the RAVE Broadcast System, contact the Office of Student Life. Once classes begin, we will do a test RAVE broadcast to ensure everyone receives the text and email.

Text Only

Email Only

Text and Email

SONIS/STUDENT ID*

Listed on Deposit Acknowledgment Letter and/or Financial Aid Award letter.

Emergency Contact Info and Relation to Student

First Name*

Last Name*

Primary Phone*

Secondary Phone

Email Address*

Second Emergency Contact Info and Relation to Student

First Name

Last Name

Primary Phone

Secondary Phone

Email Address

FERPA/Sharing of Information

Your grades and billing statement cannot be shared until the following is checked.

FERPA Information Concerning Student Records*

Eureka College is subject to the provisions of a federal law known as the Family Educational Rights and Privacy Act (FERPA), the federal law that governs release of and access to student education records. Release of this information is not done at Eureka College without the expressed, written consent of the student. For more information visit our FERPA documentation

I understand and have read FERPA

Academic Report

I consent to share, upon request, my Academic Report with (select all that apply):*

Please check all that apply. If selecting Father, Mother, or Other, you will be prompted to provide their information before submitting the form.

Self

Father

Mother

Other

Health Release

I consent to share, upon request, my Health Release with (select all that apply)*

Please check all that apply. If selecting Father, Mother, or Other, you will be prompted to provide their information before submitting the form.

Self

Father

Mother

Other

Financial Release

I consent to share, upon request, my Financial Statement with (select all that apply):*

Please check all that apply. If selecting Father, Mother, or Other, you will be prompted to provide their information before submitting the form.

Self

Father

Mother

Other

Student Conduct

Student Conduct*

Student Conduct Consent on this form is not required for students under 21 who violate drug and alcohol laws/policies or for any student whose conduct poses a risk to the safety or well-being of themself or anyone else on campus.

I understand and have read the above.

Photo Media Release

Photo Media Release*

I grant Eureka College the unrestricted right to use and publish my name and my photo for editorial, trade, advertising, and any other purposes in any manner and medium; and to alter and composite the same with restriction and without my inspection or approval. I hereby release Eureka College, and any parties contracting with the institution, from all claims and liability relating to said photographs or media productions.

I understand and have read the above

Student Handbook

Student Handbook Agreement*

As a student at Eureka College, I understand that I am responsible for knowing and abiding by the College regulations and procedures as outlined in the Student Handbook which is available on the main page of the Eureka College website, www.eureka.edu. I acknowledge that this information will be reviewed at orientation sessions (fall - Welcome Week/spring - New Student Orientation) along with being sent to all members of the campus community at the beginning of the fall and spring semesters via Eureka College email. The policies include, but are not limited to the following: Alcohol and Other Drug Policy Policies for Information Technology Academic Policies Residential Life Policies Judicial Policy and Procedures

I further understand and agree that failure to abide by the terms set forth in the Student Handbook could result in disciplinary action, up to and including dismissal from Eureka College.

Family Information

Required if student is under the age of 21. Please use spouse, relative, or guardian if parent information does not apply.

If you selected to share only with yourself, this page will not have any fields to complete. Please select Next to continue to the final step.

Fathers Information

First Name

Last Name

Address

Address 2

City

State

Zip Code

Country

Email Address

Primary Phone

Mothers Information

First Name

Last Name

Address

Address 2

City

State

Zip Code

Country

Email Address

Primary Phone

Others Information

First Name

Last Name

Relationship

Address

Address 2

City

State

Zip Code

Country

Email Address

Primary Phone

Signature and Authorization

Authorization*

By checking this box and signing this form, I certify that the above information is true and correct to the best of my knowledge.

Today's Date*

Signature*

Have Issues with Signature Box?

I'm having issues with the signature box