Admissions Information Request Form
To request information about MSSU, simply complete this online form.

*First Name: 
Middle Initial: 
*Last Name: 
Gender
*Date of Birth (MM/DD/YYYY): 
*Permanent Address: 
*City: 
*State:
*Zip Code: 
*Email: 
*Phone: 
Phone Type 
High School Name: 
Previous college 
H.S. Graduation Year: 
ACADEMIC INTERESTS
Accounting/Business Management:
Art:
Athletic Training:
Biology:
Chemistry:
Communications:
Computer Information Science:
Computer Assisted Manufacturing Tech
Computer Aided Drafting/Design
Criminal Justice:

Dental Hygiene:
Education:
EMT-Paramedic:
Engineering Technology:
English:
Environmental Health Tech:
Foreign Language:
Graphic Design:
Health Promo/Wellness:

History:
Industrial Engineering Technology:
Industrial Technology Education:
International Business:
International Studies:
Kinesiology/Physical Education:
Law Enforcement:

Mathematics:
Medical Technology:
Music:
Nursing:
Paralegal:
Physics:
Political Science:
Pre-Dentistry:
Pre-Engineering:

Pre-Law:
Pre-Medicine:
Pre-Optometry:
Pre-Pharmacy:
Pre-Physical Therapy:
Pre-Veterinary:
Psychology:
Radiologic Technology:
Respiratory Therapy:

Sociology:
Theatre:
School Activities and/or Varsity Athletics
Band:
Baseball:
Basketball:
Choir:
Dance Team
Debate:
Football:
Golf:
Soccer:

Softball:
Spirit Squad:
Tennis:
Track:
Volleyball:
Other Information:
*I plan on beginning at MSSU during:
*Year (YYYY): 
Comments/Questions: