Fillable UndergraduateQuestionnair

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UndergraduateQuestionnair

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The UndergraduateQuestionnair form is 1 page long and contains:

  • 1 signature
  • 6 check-boxes
  • 68 other fields

Country of origin: US
File type: PDF

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Undergraduate Questionnaire
Student First Name:
Student Middle Initial:
Student Last Name:
St. Thomas ID:
Sex:
Female Male
Date of Birth (MM/DD/YYYY):
Social Security Number:
Start Term/Year:
Permanent Address:
City:
State:
Zip Code:
Phone Number:
Residence at time of Admission to the University of St. Thomas:
Country:
State:
County (if state is MN):
Local Address: Where will be living while attending the University
of St. Thomas?
Permanent Address
University Housing
Other
If you have checked “Other” enter address and phone:
City:
State:
Zip Code:
Phone Number:
Parent/Guardian Information (required for Students below the
age of 18)
Parent/Guardian
First Name:
Parent/Guardian
Middle Initial:
Parent/Guardian
Last Name:
Address:
City:
State:
Zip Code:
Address to which bills should be sent to:
Parent/Guardian Address
Student Local Address
Student Permanent Address
Emergency Contact Information
First Name:
Last Name:
Phone Number:
Relationship:
Aunt/Uncle Brother/Sister Father
Grandparent Guardian Mother
Son/Daughter Spouse Other
What was the last institution you attended:
City:
State:
Zip Code:
Are you currently enrolled there:
Yes No
Citizenship Status:
US Citizen
Permanent Resident of USA
Asylee/Refugee
Marital Status:
Divorced
Legally Separated
Married
Single
Widowed
Ethnicity and Race:
Are you Hispanic or Latino? A person of Mexican, Puerto Rican,
Cuban, Central or South American, or other Spanish origin,
regardless of race.
Yes No
Check all that apply:
American Indian or Alaskan Native: A person having origins
in any of the original peoples of North or South America
(including Central America), and who maintains a tribal affiliation
of community attachment.
Asian: A person having origins in any of the original peoples
of the Far East, Southeast Asia, or the India, Japan, Korea,
Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam
Black or African American: A person having origins in any
of the black racial groups of Africa
Native Hawaiian or other Pacific Islander: A person having
origins in any of the original people of Hawaii, Guam, Samoa, or
other Pacific Islands
White: A person having origins in any of the original peoples
of Europe, the Middle East, or North America
Prefer not to respond
U.S. Military Veteran?
Yes No
Are you applying for Veteran’s Benefits?
Yes No
If yes, please contact the VA representative at the University of
St. Thomas.
I ce
rtify that the information provided is complete and accurate to the best of my knowledge.
Student Signature:
Date:
Please return this form to the Stude
nt Data & Registrar located in MHC 126 or by email registrar@stthomas.edu
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UndergraduateQuestionnair

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Completed 4 December 2019

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