Mountain State University
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After you have completed and submitted this application, contact the institutions you have attended and have them send your official transcripts to the following address:

Mountain State University
Attn: Tammy Toney
P.O Box 9003
Beckley, WV 25802-9003

International Students please use the Graduate Application in the International Student section.

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Personal Information
Full Name
First
 Last
 Middle
Maiden Name/Other
 Preferred Name
Social Security Number (XXX-XX-XXXX)
Permanent Address
PO Box or Street Address
 City
County
 State
 Zip Code
Country
    
Mailing Address
PO Box or Street Address
 City
County
 State
 Zip Code
Country
 Effective from (mm/dd/yyyy)
to
Contact Information
Home Phone
 Work Phone
 Email
Additional Information
Employer (enter "NA" if not employed)
Are you a veteran of the U.S. Armed Forces?
Do you plan to apply for financial aid?
Academic Information
When do you
plan to enroll at MSU?		 Semester

 Year
Applying for:
Status:
Select from the following program options and indicate the location or method of delivery for which you are enrolling
Location or Method of Delivery
For Master of Criminal Justice Administration, Master of Health Science, or Master of Arts/Master of Science in Interdisciplinary Studies, choose from the following locations

For Master of Science in Nursing: Administration and Education, Master of Science in Nursing:Family Nurse Practitioner, or Certificate in Nursing:Family Nurse Practitioner, choose from the following locations

For Master of Science in Strategic Leadership, select your Cohort location


Master of Science in Physician Assistant is available only at the Beckley location
College or University in which bachelors degree earned
Name
 Location (City and State)

Dates Attended (mm/dd/yyyy)

 Degree(s) Earned
from:

to:
Have you taken any of the following standardized tests? If yes, please submit official score reports and date of test
Date
 Score
Date
 Score
Date
 Score
Date
 Score
General Information
Are you eligible to return to all colleges/universities you have attended?
If no, please explain

Have you ever been convicted of a felony?

Note: A felony conviction does not automatically prohibit admission to the University.
If yes, please explain
Statistical Information
Information collected in this section is used for statistical purposes only and will not be used in any way to determine eligibility for admission.
Are you a U.S Citizen?
 If no, what is your country of citizenship?
How did you learn of Mountain State University?
If "Other", please tells us how you heard about MSU.
Why did you choose MSU?
Also please provide us with any quesitons or comments you may have.

By submitting this form you are giving your college or university permission to provide Mountain State University with any records necessary for the evaluation of your application.

Note: All information obtained for data and reporting purposes will be kept in strict confidence between its source(s), the School of Graduate Studies, and the professional staff of the University.
  
 
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Mountain State University • PO Box 9003 Beckley, WV 25802
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THIS SCHOOL IS AUTHORIZED UNDER FEDERAL LAW TO ENROLL NONIMMIGRANT ALIEN STUDENTS.