MSU Denver Office of Admissions
Student Success Building | Counter #1
Campus Box 16 PO Box 173362
Denver, CO 80217
Fax Number:720-778-5794
Phone Number: 303-556-3058
msudenver.edu/admissions | admissions@msudenver.edu
Citizenship / Visa Type Form
Page 1 of 1
Revised Date Office Code
Name:
_____________________________________________________________________
Date of Birth:
____________________________
Student ID Number
___________________________
Email:
Phone Number:
_____________________________
I affirm that I have read, understand, and agree to this form in its entirety and that the information supplied is true and complete.
Signature:
___________________________________________________
Date:
_____________________
Please check one:
US Citizen (Submit proof of citizenship)
Permanent Resident (photocopy of green card required)
Asylee / Refugee (Submit copy USCIS Notice of Action or Employment Authorization Card
Adjustment Applicant (Submit copy USCIS Notice of Action or Employment Authorization
Card)
DACA/Undocumented
Current Visa Holder (documentation required) - international students submit this form to
international admissions.
Current Visa Holder Visa Type: _____________
Seeking F-1 Visa Submit this form to intladmissions@msudenver.edu
I hereby certify that, to the best of my knowledge, the information provided on this form is true and
complete.
Student:
_______________________________________
__________________
Signature
Date
Parent/Guardian*:
______________________________
__________________________________
____________
Print Name
Signature
Date
*If student is under 18 years of age, a parent’s or guardian’s signature is required
click to sign
signature
click to edit
click to sign
signature
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