Mississippi Valley State University

M ississippi V alley S tate U niversity

APPLICATION FOR UNDERGRADUATE ADMISSIONS

Name________________________________________________________________________________________________________

Last First Middle/Maiden

Address:________________________________________ City: __________________________State:_______Zip Code:___________

County: ____________________ Phone: () __________ _____Male _____Female Date of Birth:______/______/______

Country of Citizenship: _______________________ Type of VISA: _________ VISA Expiration: ________ Race: __________

Have you taken the: ______ SAT ______ ACT Date taken: _______/_______/________ Score: ________________

High School Code: _____________ High School Attended:___________________________ Graduation Date: ________________

College(s) Attended (Most Recent First) Address Dates Attended

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

_____________________________________________________________________________________________________________

You must have an official transcript from each college attended mailed to the Office of Admissions (See Address below)

Do either of your parents/guardians with whom you lived with until the age of 18 have a bachelor's degree from a four (4) year college or university? Yes () No ()

Please list a contact person in case of emergency:

_____________________________________________________________________________________________________________

Name Address Telephone Relationship

Entrance Date: _________ FALL ________ SPRING _______SUMMER I ______ SUMMER II YEAR _________

I will enroll at the: _____MAIN CAMPUS ______GREENVILLE CENTER ______GREENWOOD CENTER

Please check the major area of study and special interests:

____Accounting ____History ____Baseball ___Softball (W)

____Art ____Industrial Technology ____Basketball (W/M) ___Tennis (W/M)

____Automated Information Technology

____Biology ____Mathematics ____Bowling (W) ___Track (W/M)

____Business Administration ____Mathematics Education ____Football (M) ___Volleyball (W)

____Chemistry ____Music ____Golf (W/M) ___Soccer (W)

____Communications ____Music Education ____Army ROTC ___Choir

____Computer Science ____Office Administration ____Band ___Honors Program

____Criminal Justice ____Political Science ____Cheerleader ___Newspaper

____Elementary Education ____Public Administration ____Dance Team

____English ____Science Education

____English Education ____Social Science Education Expected Enrollment Classification:

____Environmental Health ____Social Work ____Freshman _____Special

____Health, Physical Education ____Sociology ____Transfer _____Readmit

and Recreation ____Speech

____Early Childhood Education ____Undecided

To be completed by all applicants: “I understand that withholding information requested in this application or giving false information may make me ineligible for admission to, or continuation at, Mississippi Valley State University. With this in mind, I certify that all information pertaining to this application is correct and complete.”

Signature________________________________________________ Date ________________________________________________

Mississippi Valley State University offers equal educational opportunities to all persons without regard to sex, race, religion, national origin, physical or mental handicap, or age by applicable laws and regulations.

Mailing Address: Mississippi Valley State University - Office of Admissions and Recruitment

14000 Hwy 82 West #7222, Itta Bena, MS 38941-1400

Дата добавления: 2015-10-21