Mountain State University
  
   

International Graduate Application
Red Text Indicates Required Fields.
Personal Information
Full Name
First
Last (family name)
 Middle
Maiden Name/Other
 Preferred Name
Permanent Address
PO Box or Street Address
 City
Zip Code
  
Country
  
Mailing Address (if different)
PO Box or Street Address
 City
Zip Code
  
Country
 Effective from (mm/dd/yyyy)
to
Contact Information
Home Phone
 Work Phone
 Email
Emergency Contact Information
Person to contact in case of emergency
  
Phone
 Relationship
 Email
Additional Information
Employer (enter "NA" if not employed)
Do you plan to apply for financial aid?
International Student Information
Please provide us with the following information

Birth Country

Birth Date (mm/dd/yy)
Month / Day / Year

Country of Valid Passport
Visa Type
If Other, please fill in this field

Expiration Date (mm/dd/yyyy)
Academic Information
When do you
plan to enroll at MSU?		 Semester

 Year
Select from the following program options and indicate the location or method of delivery for which you are enrolling
Colleges and Universities Attended
Name
 Location (City and State)

Dates Attended (mm/dd/yyyy)

 Degree(s) Earned
from:

to:
Name
 Location

Dates Attended (mm/dd/yyyy)

 Degree(s) Earned
from:
to:
Name
 Location

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.
Gender
  
Marital Status

Spouse's Name

Number of children or dependents

  
List names of family members who will come to the US with you, along with their date of birth and country of citizenship.
What is your country of citizenship?
Ethnic Origin
  
Do you have a handicap or disability?
 If yes, will you require special assistance?
  
How did you learn of Mountain State University?
If "Other", please tells us how you heard about MSU. Or enter the name of your local recruiter
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.
  
Programs | Financial Aid | Library | Mountain State University Academy | Contact Us | Job Listings | Employee E-mail
304.929.INFO 866.FOR.MSU1 Online Learning Click here for locations near you
Legal Statement | ©2009 Mountain State University. All Rights Reserved. Mountain State University is authorized under federal law to enroll nonimmigrant alien students. Mountain State University is accredited by the Higher Learning Commission and a member of the North Central Association (312.263.0456, www.ncahigherlearningcommission.org).