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Criminal Background Release Form

The Admissions Application requires applicants to report all criminal convictions, other than minor traffic violations in order to assess the suitability of such applicants to the University community and identify any special conditions for enrollment.
 

This form is to certify that the following is a complete list of my convicted criminal offenses.
 

Please take a moment to review and acknowledge your understanding and acceptance of this agreement. All boxes must be filled-in and you must affix your electronic signature where indicated in order to continue.

By electronically signing the Criminal Background Release Form, I certify that the below listed information is a complete list of my criminal offenses. I authorize the Morehead State Police Department to review and verify my criminal history and release the findings to Enrollment Services, Office of Admissions.
 

I HEREBY AUTHORIZE any law enforcement agency and court to release the Morehead State University Police Department information on any and all of my charges.
 

I acknowledge and agree that the individual completing this electronic account application is the individual whose name the account is being requested.

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If you do not have a driver's license, enter another form of ID, such as a State-issued ID or driver's permit.
By checking this box, I accept this agreement electronically:

 

  • Please note that submission of this form constitutes an electronic signature, which is used in lieu of your handwritten signature. Your electronic signature is consent that all information provided is correct and that you agree to the terms.
  • Applicant authorization expires six months of receipt of release form. 
  • This form is not submitted via a secure website. If you have concerns about the privacy of your information, you may print this form and send it to:
Morehead State University
Office of Enrollment Services
Attn: Myra Mayse
100 Admissions Center
Morehead, KY 40351
  • Morehead (Residential Campus)
    150 University Blvd., Morehead, KY 40351
    1-800-585-6781
  • MSU at Ashland
    1400 College Drive, Ashland, KY 41101
    800-648-5370
  • MSU at Mt. Sterling
    3400 Indian Mound Drive, Mt. Sterling, KY 40353
    859-499-0780
  • MSU at Prestonsburg
    6 Bert Combs Drive, Prestonsburg, KY 41653
    800-648-5372
  • MSU at West Liberty
    155 University Drive, West Liberty, KY 41472
    606-743-1500
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