Application for enrollment - Morgan State University

RETURNING DEGREE CANDIDATES - DO NOT USE THIS APPLICATION.Call the Office of Records and Registration at 443-885-3300 for re-admission instructions.Write your social security number on your check or money order - DO NOT SEND CASH - Print legibly with CAPITAL LETTERS,without touching the sides of the entry boxes. Use blue or black ink pen. Fill in circles completely, and return all pages.$25 non-refundable application fee or fee waiverOffice Userequired1. Identification DataMr.Ms.Mrs.APPLICATION FOR ADMISSIONFull Name (Last First Middle) Please leave one (1) blank space between each name/initial.Social Security Number- -Leave a single space between names please.Date of Birth (MM DD YYYY)- -Other/Maiden NameMorganState UniversityOffice of Admission and Recruitment1700 East Cold Spring LaneBaltimore, MD 21251Preferred Entrance Semester:FallSpring 20012012012012012012012012012012012012012012012012012Ethnic GroupWhite American Indian/Alaskan NativeBlackHispanicAsian or Pacific IslanderOtherSexMaleFemaleResidency StatusResidentNon-Resident345678345678345678345678345678345678345678345678345678345678345678345678345678345678345678345678345678Are you a :Vet eligible for benefits Vet not eligible for benefits Vocational RehabilitationActive Duty Spouse of Dec/Tot Dis Vet Child of Dec/Tot Dis VetChild of Dis Vet Non-VeteranDependent of deceased War VetAre you a U.S. Citizen? Yes NoAll Non-Citizens must complete section 8999999999999999992. All Addresses(A) Permanent/Legal AddressAddressThis address is the same for Billing and Mailing. If "Yes", move on to section D15083City State Zip CodeCountyE-mail AddressCountry-Phone Number- -RE-PRINT YOUR SOCIAL SECURITY NUMBER HERE: - -1

(B) Mailing AddressAddressCity State Zip Code(C) Billing AddressAddress-City State Zip Code(D) Emergency ContactEmergency Contact's Full Name (Last First Middle)Leave a single space between names please.-AddressCity State Zip CodePhone--Relationship of ContactAdvisor Aunt/Uncle Billing Organization Sibling Child Embassy Parent Grandparent Sponsor Foster Parent Other(E) Alumni RelationshipAlumni Relationship:Are you related to an Alumni? Yes No Parent(s) Sibling(s) Aunt Cousin Grandparent Uncle150833. Entry ProfileIntended MajorEntry LevelFreshmanTransferA Non-Degree StudentSecond Bachelors DegreeTime StatusPart Time - DayPart Time - EveningFull Time - DayFull Time - EveningRE-PRINT YOUR SOCIAL SECURITY NUMBER HERE: - -2

4. Academic HistoryA. Secondary Education: Name & Location of school which issued or will issue your high school diploma.CEEB NumberSchool NameAddressCity State Enrolled From (MM YYYY) To (MM YYYY)Have you received a diploma from this institution? Yes No Not yetIf no high school diploma, have you received a GED? Yes NoIf no high school was attended, were you Home Schooled? Yes NoB. Colleges/Universities: Name and location of the most recent college attended, whether credit was earned or not. Include credits attempted and/or completed atMorgan State University.CEEB NumberSchool NameAddressCity State Enrolled From (MM YYYY) To (MM YYYY)Degree SoughtEarned?YesNoTerm Hours.Hrs. PursuingCEEB NumberSchool NameAddressCity State Enrolled From (MM YYYY) To (MM YYYY)Degree SoughtEarned?YesNoTerm Hours.Hrs. Pursuing15083RE-PRINT YOUR SOCIAL SECURITY NUMBER HERE: - -3

Previous AddressCity State Zip Code-Did you attend High School in Maryland? Yes NoAre you, your spouse, or either of your parents a regular employee of Morgan State University? Yes NoAre you, your spouse, or either of your parents a full time active member of the U.S.Armed forces whose home or residency is Maryland, or who resides or is stationed inMaryland? If Yes, please attach a copy of your most recent orders.YesNoAre you a graduate assistant at Morgan State University?YesNoAre you living in Maryland primarily for the purpose of attending an institution of highereducation?Do you own, rent or occupy living quarters in Maryland?If Yes, when did you commence your ownership or rental?YesYesNoNo(MM YYYY)Are all or substantially all of your possessions in Maryland?YesNoList the state(s) and year(s) in which you have filed income tax returns for the past two years.StateYearStateYearIf you haven't filed a tax return in Maryland, please state the reason.Is Maryland State income tax currently being withheld from your paycheck?If not, please state the reason.YesNoDo you possess a valid drivers's license?If Yes, in what state was it issued andwhen is the date of original issue?YesNoStateDate of original issue (MM-DD-YYYY)- -Do you own any motor vehicles?If yes, please state the make and model of eachvehicle and the state(s) in which they're registered.YesNoMake Model StateMake Model State15083Are you registered to vote?If Yes, in which state?YesNoStateRE-PRINT YOUR SOCIAL SECURITY NUMBER HERE: - -5

Do you receive public assistance? If so, please provide the complete name and address of the agency providing the public assistance.I certify that the information above is complete and correct.Signature of ApplicantDate Signature of SupporterDate8. International ApplicantsCountry of Citizenship Country of Birth Do you need an I-20YesNoNative LanguageSecondary LanguageAVisa Holders (All visa holders must submit proof of visa status)Permanent Resident Alien Registration Number Other (Please State)- -Refugees -- Date Refugee status was received(MM - DD - YYYY)- -F-1. What Institution issued the I-20One person in the U.S. may be designated as your agent to inquire about your admission status. Name your agent here:Summary of Educational Experiences by YearsTOEFL required of applicants from countries where English is not the language of instruction in secondary school.TOEFL Test Date (MM/YYYY)/15083RE-PRINT YOUR SOCIAL SECURITY NUMBER HERE: - -6

Year inSchoolAcademic YearMM/YYYY to MM/YYYYYour Age GradeStandardKind of School(P)rimary, (E)lementary,(S)econdary, (H)igh School,(U)niversity, (O)rdinary Level,(A)dvanced Level1To/ /P E S H U O A2To/ /P E S H U O A3To/ /P E S H U O A4To/ /P E S H U O A5To/ /P E S H U O A6To/ /P E S H U O A7To/ /P E S H U O A15083RE-PRINT YOUR SOCIAL SECURITY NUMBER HERE: - -7