Minnesota State Applicaon for Admission // 3
OFFICE USE ONLY
DATE DATE ACCEPTED _ APPLICATION FEE PAID RECEIVED__________________________ _______________________________ _____________________________
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PERSONAL INFORMATION
Full Legal Name (Last, First, Middle)
Enter your name as it appears on your U.S. Social Security Card or passport.
Date of Applicaon
Name used in high school records or in other educaonal records and transcripts, if dierent from above (Oponal) (Last, First, Middle)
Preferred Name (Oponal) (Last, First, Middle)
Students may request that their “Preferred Name” be dierent from their legal name of record. The “Preferred Name” will be used where possible in the course of Minnesota State College
and University business.
Social Security Number
Providing your Social Security number is voluntary. If you do not provide this number, your applicaon will sll be
processed. Many colleges/universies use Social Security numbers for student idencaon purposes on internal student
records. The number may be used for purposes of administraon, program evaluaon, consumer and alumni data, and
also may be used to create summary informaon about system programs through data matches with other state agencies.
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Current mailing address City State Zip County
Permanent address, if dierent from above
City State Zip County
Personal Phone Work Phone Email Address
( ) ( )
Are you a resident of Minnesota? If yes, how long? If no, of which state are you a resident? ___________________
Yes No Years _____ Months _____
Yes No
If you answered no, do you have status as:
Are you a U.S. cizen?
Resident alien Refugee/asylee Temporary protected status None of these
If you answered none of these, do you have or intend to apply for a visa? Yes* No
*If you answered yes, you must contact the internaonal student oce at the college or university you wish to aend to determine whether a separate applicaon is required.
Answer the following two quesons only if you wish to qualify for in-state tuion and are NOT one of the following: a U.S. cizen; an
internaonal student maintaining valid immigraon status as a non-immigrant; or a permanent resident, refugee, or have been granted
temporary protected status:
1. When you graduate from high school, will you have aended a high school in Minnesota for three or more years? Yes No
2. To qualify for resident tuion under the Prosperity Act, male students between the ages of 18 and 25 must have registered with the Selecve Service
System. Please indicate one of the following:
I have registered with Selecve Service I have not registered with Selecve Service
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I am not required to register for Selecve Service
What is the highest level of educaon for your parent(s)/guardian(s)? Please respond for the parent(s), step-parent(s), adopve parent(s), or
guardian(s) who raised you. Check only one box for each parent/guardian.
Parent/Guardian #1
No high school diploma High school diploma Some college
Two-year college degree/diploma Bachelor’s degree or higher Not sure/don’t know
Parent/Guardian #2
No high school diploma High school diploma Some college
Two-year college degree/diploma Bachelor’s degree or higher Not sure/don’t know
ADMISSION INFORMATION
Name of Minnesota State college or university to which you are applying
Use a separate copy of the applicaon form for each instuon.
Name of program, major, or curriculum you plan to follow (e.g., English, electrical/engineering, auto mechanics, nursing)
Check college/university policies for admission requirement to specic programs of study. List up to three (3).
Select Campus
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