Foundation Scholarship Application

Missouri Southern State University emphasizes the dignity and equality common to all persons and adheres to a strict nondiscrimination policy regarding the treatment of individual faculty, staff, students, third parties on campus, and applicants for employment and admissions. In accord with federal law and applicable Missouri statutes, the University does not discriminate on the basis of race, color, religion, national origin, sex, sexual orientation, gender identity, pregnancy, ancestry, age, disability, genetic information, veteran status, or any other legally-protected class, in employment or in any program or activity offered or sponsored by the University, including, but not limited to, athletics, instruction, grading, the awarding of student financial aid, recruitment, admissions, and housing.

Personal Information *Last Name   Middle Initial   *First Name   *Do you have a SID (MSSU Student ID#)?   If you do not have a SID enter your Social Security Number   *Will you be enrolled in 12 or more credit hours? No Yes *Gender: Male Female *Are you transgender? No Yes *Phone:   *Email Address:   *Mailing Address:   *City:   *State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming *Zip Code:   *Are you a current resident of one of these local counties? No Barry MO Barton MO Dade MO Jasper MO Lawrence MO McDonald MO Newton MO Stone MO Benton AR Carroll AR Delaware OK Mayes OK Ottawa OK Cherokee KS *Do you live on or off-campus? On-campus Off-campus Ethnicity *Ethnicity (Select One): Black Non-Hispanic American Indian or Alaskan Native Asian - Non Korean descent Asian of Korean Decent Hispanic or Latino Hispanic or Latino - Mexican-American White Non-Hispanic Native Hawaiian/Pacific Islander Multiple Races (Non-Hispanic) Decline to Answer Citizenship *Are you a US citizen? I was born a US citizen. I gained citizenship through naturalization. I am undocumented and fall under DACA classification. I am not a US citizen.

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