UNDERGRADUATE ADMISSION
AND
SCHOLARSHIP APPLICATION
OFFICE OF ENROLLMENT SERVICES
100 ADMISSIONS CENTER
MOREHEAD, KY 40351
Mail completed form, any required transcript(s) and test
scores, and non-refundable $30 application fee (check or
money order payable to MSU) to:
www.MOREHEADSTATE.EDU
MOREHEAD STATE UNIVERSITY
1. Legal name __________________________________________________________________
Last
First
Middle
Other name(s) under which records may be filed ________________________________________________
2. Social Security Number __________________________
3. Birth date ___________________
4. Permanent address ___________________________________________________________
Number and street
__________________________________________________________________________________________
City
State
How long have you lived at the above address? ____________
years
5. E-mail address _____________________________
7. Sex
q Male
Zip Code
County
____________
months
6. Phone (
q Female
) __________________
q Home
8. Applying as which type of student?
q Cell
q First-time freshman
q Returning student - previously attended MSU _______________________________________________
Dates attended:
From
To
q Transfer student (List previous colleges or universities attended below and submit official transcripts)
College/University
City, State
Dates Attended
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
q Visiting student (Will provide a visiting student statement and transfer credits back to home institution)
q Special/Non-Degree student (Not pursuing a degree, e.g. taking courses required for employment)
q Auditor student (Not attending for credit)
q Post-Bachelor’sstudent (Taking additional undergraduate courses after graduation)
9. Completed q High School _____________
Graduation Date
q Home School _____________
q GED _____________
Test Date
Completion Date
10. High School __________________________________________________________________
City__________________________________________ State __________________________
11. Test(s) taken
q ACT ___________________
12. Applying to enroll
OFFICE USE ONLY
Dates
q Fall (August) _________
R E C. # / CK . #
Year
DATE
q SAT ___________________
q Spring (January) _________
Year
ID
Dates
STATUS
q Summer _________
Year and Term
BY
13. Anticipated major _____________________________________________________________
Use academic program description found in Undergraduate Catalog or at www.moreheadstate.edu/prospective
14. Degree planning to complete q Bachelor’s (4 year)
15. Ethnic origin
16. Marital status
17. Citizenship
q African American
q Hispanic
q Single
q Associate (2 year)
q American Indian/Alaskan Native
q Caucasian (White)
q Married
U.S. citizen? q Yes q No
q Divorced
q Not seeking degree
q Asian/Pacific Islander
q Widowed
q Separated
If no, Resident Alien? q Yes q No
Citizenship country _______________________________
18. Emergency contact information ___________________________________________________
Nearest relative’s name
Relationship
___________________________________________________________________________
Address - number and street
___________________________________________________________________________
City
State
Zip Code
(
)
___________________________________________________________________________
E-mail address
Area code
Phone number
19. Have you even been convicted of a criminal offense other than a traffic violation? q Yes q No
If yes, download Background Release Form from our Web site and return with your application. (Minor traffic offenses, e.g., seat belt
violoations are exempt. Other charges resulting from traffic stops, e.g., drug possession and DUI must be reported.)
20. Where do you intend to live?
q MSU residence hall
q at home
q off-campus housing
You must be admitted to MSU before you apply for on-campus housing. Please familiarize yourself with the mandatory housing and
dining policy. Admission to MSU does not guarantee on-campus housing.
21. Do you intend to apply for financial aid? q Yes q No
22. Musicial activities (indicate desired interest)
q marching band
q bands/orchestra
23. Scholarship information - Mark your past honors, programs or activities
q Kentucky Governor’s Scholarship Program alumnus
q National Merit finalist or semi-finalist
q Honors/AP/IB classes
q chorus
q Kentucky School for the Arts alumnus
q Rogers Scholars Program alumnus
q Other organizations or activities _____________________________________________________
24. List parent or grandparent who attended MSU _______________________________________
Name
Relationship
Morehead State University may, from time to time, desire to use my photograph and/or personal data, including academic records, for publicity purposes for the University.
I have read this statement and understand it, and hereby state that I do not object. (If you do object, you must notify the Media Relations Director in writing at 14 Allie
Young Hall, Morehead, KY 40351.)
I agree to adhere to the rules and regulations of the University and certify that all statements in this application are true. I also understand that any misrepresentation of
information will make me ineligible for admission to Morehead State University or subject to dismissal after admission has been granted.
Applicant’s signature __________________________________________________________
Date ____________________
OUR COMMITMENT TO YOUR RIGHTS: We are committed to your rights as a student and as an applicant to Morehead State University. Therefore, we take seriously
and adhere to the following policies. Non-Discrimination Policy: MSU is an affirmative action, equal opportunity, educational institution; NACAC
Statement of Good Practice: MSU is a member of the National Association for College Admission Counseling (NACAC) and complies with the NACAC
Statement of Principles of Good Practice; Family Educational Rights and Privacy Act of 1974: FERPA, or the Buckley Amendment is a federal law
designed to protect the privacy of a student’s educational record. Without specific, written permission from you, we will not discuss your application for admission
with any other individual, except as provided within this Act.
Revised August 2008
606-783-2000 n 800-585-6781 n E-mail: admissions@moreheadstate.edu