Minnesota State University Moorhead is an equal opportunity educator & employer and is a member of the Minnesota State Colleges & Universities System.
This information will be made available in alternate format, such as Braille, large print or audio cassette tape,
upon request by contacting Disability Services at 218.477.2131 (voice) or 1.800.627.3529 (MRS/TTY).
International Application for Readmission - Return to:
Director of International Student Services
Dragon ID: ________________________________
Name: ___________________________________________________________________ Social Security #: _____________________
Permanent Address: ______________________________________________________________________________________________
Street City State Zip
Local Address: __________________________________________________________________________________________________
Street City State Zip
Permanent phone: _________________ Local phone: _________________ Cell phone: _______________ Birthdate: ____________
State Residency: ______________________________ How long have you lived there: ___________ years ____________months
e-mail: __________________________________________________________________________________________________________
1. Semester returning: Fall Spring Summer Year starting ________
2. I have attended the following institutions and will arrange to have ALL transcripts sent to MSUM as soon as possible. I will request transcripts
from ALL schools I have attended including any schools with registration and unearned credit s, withdrawals, or complete withdra wals.
Institution Name: ____________________________________________________ Dates Attended: ____________________________
Institution Name: ____________________________________________________ Dates Attended: ____________________________
Please have official transcript(s) sent to: International Student Services, MSUM CMU 229, 1104 7
th
Ave S, Moorhead, MN 56563
I now hold a AA BA BS BFA BM BSW BSN MA MS MFA MLA Spc.
degree from ___________________________________________________________________________________________________
Name of Institution
3. Check the statement describing your academic program at MSU Moorhead.
Seeking Bachelor’s degree. Major_____________________________________________________ teaching non-teaching
Other: ____________________________________________________________________________________________________
4. SEVIS Relase Form from: ----------------------------------------------------------------------------------------------------------------------------------.
5. Please read the following conditions that apply to your readmission and sign below:
I certify that I have provided all information as completely and accurately as possible.
I understand that transfer credits not reported before readmission may be disallowed and academic suspension at another
institution, if unreported, is cause for cancellation of enrollment.
Signature __________________________________________________________________________ Date _____________________
The information collected is used for summary reports required by Federal and State laws and for MSUM institutional research. Refusal to
provide any of the requested information will not subject you to adverse treatment. Submission of this information is volun tary.
All documents must be submitted at least 30 days prior to registration for the term desired Transfer Form & Bank Statement
International Readmissions Form
Return to: Director of International Student Services
click to sign
signature
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