Fillable Application for Admission (Minnesota State University Moorhead)

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Application for Admission (Minnesota State University Moorhead)

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The Application for Admission (Minnesota State University Moorhead) form is 2 pages long and contains:

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  • 45 check-boxes
  • 49 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Minnesota State University Moorhead

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Full Legal Name: ____________________________________________________________________________________________________________________________________________________________________
First Middle or Previous Last Name(s) Last
Permanent Address: _________________________________________________________________________________________________________________________________________________________________
Street City State Zip County
Present Mailing Address (if dierent from above): ________________________________________________________________________________________________________________________________________
Street City State Zip County
Home Phone #: ______________________________________ Cell #: ___________________________________ E-mail: _____________________________________________________________________________
State in which you are a resident: ____________ How long? years: ______ months:_______ Social Security Number (optional): _____________________________________________________________________
Semester you wish to enter: Fall Spring Summer Year _________ Do you plan to attend: Full time (12 or more credits) Part time (fewer than 12 credits)
Indicate major or area of interest in order of preference; if unsure, write “Undecided.” ___________________________________________________________________________________________________________
Application type: Freshman Transfer Returning PSEO Complete courses, but not a degree (NOTE: Not eligible for nancial aid and are not assigned advisors.)
Are you a U.S. Citizen? Yes No
If no, check the correct status: Permanent resident alien Refugee Asylee
If you are not a citizen or permanent resident alien, indicate the type of visa you have: _____________________________________________________
Name(s) of parent(s), guardian or spouse: _____________________________________________________________________________________________________ Relationship: ___________________________
Street Address: _____________________________________________________________________________ City/State/Zip: __________________________________________________________________________
Phone: _______________________________________________ E-mail: ____________________________________________________________________________________________________________________
Name of High School: ______________________________ H.S. City/State: ______________________________ Date of graduation: _____________________ OR Date completed GED: ______________________
Will you be receiving college or Advanced Placement credit for courses taken while in high school? Yes No
Will you be receiving college credit for courses taken while in high school? Yes No
If you have attended or enrolled at another college, technical or post secondary school, please list below. (Include PSEO or college attendance in H.S.)
_____________________________________________________________________ ________________________________________________________ ____________ ______________ ___________________
Name of School City and State Dates Attended Credits Completed Degree/Diploma received
_____________________________________________________________________ ________________________________________________________ ____________ ______________ ___________________
Name of School City and State Dates Attended Credits Completed Degree/Diploma received
_____________________________________________________________________ ________________________________________________________ ____________ ______________ ___________________
Name of School City and State Dates Attended Credits Completed Degree/Diploma received
Send ocial transcript from each post-secondary school attended. This is university policy and failure to list all institutions attended is considered fraud and is
sucient grounds for cancelling admission.
I certify that the information I have provided on this application and on all other admission materials is complete, accurate and true to the best of my knowledge.
Applicant Signature: __________________________________________________________________________ Date: _____________________________________________________
Application for Admission
Questions?
Need Help?
admissions@mnstate.edu
p: 218.477.2161
mnstate.edu
application continued on back
click to sign
signature
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(Application Continued)
Providing the following information is voluntary and will not be used as a basis for admission.
Social Security Number
Many institutions, including MSUM, request and use your Social Security Number for student identication purposes. While
you are not legally required to provide it, you are strongly encouraged to do so. Your number may be used for institutional
statistics, research and required state and federal reporting.
Gender Male Female
Are you Hispanic or Latino? (A person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish
culture, regardless of race)
Yes
No
Race and ethnic background (select one or more)
Unknown
Black or African American
A person having origins in any of the black racial groups of Africa
Asian
A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent
White
A person having origins in any of the original peoples of Europe, the Middle East or North Africa
American Indian or Alaska Native
A person having origins in any of the original peoples of North, Central or South America and who maintains tribal
aliation or community attachment
Native Hawaiian/Other Pacic Islander
A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacic Islands
What is the highest level of education for your parent(s)/guardian(s)?
Please respond for the parent(s), step-parent(s), adoptive parent(s) or guardian(s) who raised you.
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 attended MSU Moorhead
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 Parent attended MSU Moorhead
Did either of your parents/guardians receive a degree from MSU Moorhead? Yes No
NOTE: The college/university is asking you to provide information that includes private and/or condential information under state and federal law. The college/university is asking for this information in order to process your application. You are not legally required to provide the information the college/university is requesting;
however, the college/university may not be able to eectively process your application if you do not provide sucient information. With some exceptions, unless you consent to further release of private information, access to this information will be limited to school ocials, including faculty who have legitimate educational interests
in the information. Under certain circumstances, federal and state laws authorize release of private information without your consent:
▸ to other schools in which you seek or intend to enroll, or are enrolled, if you are rst notied of the release; ▸ to federal, state or local ocials for purposes of program compliance, audit or evaluation; ▸ as appropriate in connection with your application for, or receipt of, nancial aid;
▸ to your parents, if your parents claim you as a dependent student for tax purposes; ▸ if information is sought with a subpoena, court order, or otherwise permitted by other state or federal law, and ▸ to an organization engaged in educational research or accrediting agency.
Minnesota State Colleges and Universities abide by the provisions of Title IX and other federal and state laws forbidding discrimination on the basis of sex, race, color, national origin or handicap and all other state and federal laws regarding equal opportunity. If you have been arrested, charged or convicted of any criminal oense,
you should investigate the impact that the arrest, charge or conviction may have on your chances of employment in the eld you intend to study or on your chances to obtain federal, state, and other higher education nancial aid.
Minnesota State University Moorhead is an equal opportunity educator and employer and is a member of the Minnesota State Colleges and Universities System. This information will be made available in alternate format upon request by contacting Disability Services at 218.477.4318(voice) or 1.800.627.3529 (MRS/TTY).
Follow These Steps...
. Mail Application Materials to:
Oce of Admissions
Minnesota State University Moorhead
 th Avenue South
Moorhead, MN 
Complete and sign the form on the
opposite page.
. Send Your Ocial Transcripts:
From every post-secondary school you’ve
attended. For a transcript to be ocial,
it must be mailed from the school to
MSU Moorhead, or hand-delivered in a
sealed envelope.
. Supply your ACT or SAT Score:
Request a copy of your score(s) be sent to
MSU Moorhead.
. Submit  application fee.
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Application for Admission (Minnesota State University Moorhead)

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Completed 1 October 2020

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