Metropolitan State University - Where life and learning meet.

» D2L » Portal

Home > Undergraduate Resources > Non-degree Seeking >

Names

* First Name
Middle Name
*Last Name
Previous Names

Permanent Address

* Address Line 1
Address Line 2
*City
* State
* Zip	e.g. 55106
County	e.g. Ramsey

Current Mailing Address (if different)

Address Line 1
Address Line 2
City
State
Zip	e.g. 55106
County	e.g. Ramsey

Home Phone Number	( ) -
Cell Phone Number	( ) -
* Email Address
* Confirm Email Address

*Citizen/Resident

Are you citizen of the United States? Yes No
If no, select your status :
Select your country of origin:
Years: Months:

* I wish to register for Metropolitan State University courses because I seek:

Undergraduate courses with the intention of being admitted

Undergraduate courses as a lifelong learner

Graduate courses with the intention of being admitted

Graduate courses as a lifelong learner

*I wish to begin classes : Semester Year (yyyy)

Educational Experience

* High School diploma

GED

None

* Year Received
* Institution
* City
*State
* Country

*Have you previously attended any colleges or universities? Yes No

Institution Information (please list 3 most recent college/universities attended)

Institution 1
City
State
Country

Institution 2
City
State
Country

Institution 3
City
State
Country

*Have you attended Metropolitan State University before? Yes No

Last attendance: Semester Year

Have you submitted an application for undergraduate admission? Yes No
Semester Year

Have you submitted an application for graduate admission? Yes No
Semester Year

Confidential Information *Birthdate: / / (mm/dd/yyyy)

(necessary for establishment in the registration system)

Gender: MaleFemale

Are you Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture, regardless of race)? YesNo

Racial background: (select any that apply)

American Indian or Alaskan Native: A person having origins in any of the original peoples of North and South America (including Central America) who maintains cultural identification through tribal affiliation or community attachment

Asian: A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent.

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 peoples 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 Africa.

Have you served in the armed forces? Yes No

Signature required by all non-degree seeking students.

* I certify that the information given on this form and on all other registration materials is complete and correct to the best of my knowledge. I understand that falsification of information on this form may be cause for Metropolitan State University to void my registration or take other appropriate action.
**Note: You must sign your request by entering your name and date below.

Signature*	Date* (mm/dd/yyyy)

* Metropolitan State University is asking you to provide information that includes private and/or confidential information under state and federal law. We are asking for this information in order to process your enrollment form. You are not legally required to provide the information the college/university is requesting; however, the university may not be able to effectively process your application if you do not provide sufficient information. With some exceptions, unless you consent to further release of private information, access to this information will be limited to school officials, 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.

Saint Paul Campus
700 East Seventh Street, Saint Paul, MN 55106

Copyright © 2011 Metropolitan State University. An equal opportunity educator and employer. A member of
Minnesota State Colleges & Universities (MnSCU)

Contact Us :: Disclaimer :: Disability Services