First Name:
Last Name:
Mailing Address:
City:
State:
Zip Code: (5 digit)
Primary Phone Number: (with area code)
Secondary Phone Number: (with area code)
Primary E-Mail:
Ethnicity: Are you Hispanic or Latino: No Yes
Race: Black/African American American Indian or Alaskan Native Asian Native Hawaiian or other Pacific Islander White/Non Hispanic
High School or College currently attending:
High School graduation year:
Enrollment Type: First Time Freshman Transfer Student Returning Student
When do you plan to enroll at MSU: Fall Spring Summer Year: 2012 2013 2014 2015
Anticipated Major: Accounting Agriculture Science Agronomy Animal Science Equine Science Appalachan Studies Art & Design Biology Business Chemistry Coaching Communication Computer Information Systems Computer Science Creative Writing Criminology Earth & Space Science Teaching Earth Systems Science Economics Education Engineering Technology English Environmental Science Exercise Science Finance French Geography Geology Government Health History Horsemanship Imaging Sciences Industrial Technology Interdisciplinary International Studies Interdisciplinary Women's Studies Integrated Science Legal Studies Linguistics Literature Management Marketing Mathematics Statistics Military Science Music Nursing Paralegal Studies Philosophy Physical Education Physics Pre-Chiropracty Pre-Denistry Pre-Engineering Pre-Forestry Pre-Law Pre-Medical Technology Pre-Medicine Pre-Optometry Pre-Pharmacy Pre-Physical Assistant Pre-Physical Therapy Pre-Podiatric Medicine Pre-Veterinary Medicine Psychology Regional Analysis & Public Policy Religious Studies Respiratory Care Social Studies Social Work Sociology Space Science Spanish Sport Management Technology Management Theatre University Studies Veterinary Technology
I am a YMCA Black and/or Latino Achievers Program Alumnus? No Yes
If selected yes, please state which program:
How did you hear about MSU's Spring 2011 Diversity Day? (Select) Facebook Twitter MSU Website Enrollment Services Counselor College Fair or High School visit TV advertisement Magazine Newspaper Radio Mail (postcard, letter, ect.) Other
If you selected other, please explain:
If you live in Lexington, Louisville, or Cincinnati, Ohio MSU can provide transportation to Diversity Day if needed. The following questions are for those needing transportation.
Do you require transportation to Diversity Day? No Yes
Which city do you reside in? (Select) Lexington Louisville Cincinnati, Ohio
Number of seats to reserve. (Please include yourself in the number): *Note there is limited seating available.
Phone: 1.800.585.6781
Fax: 1.606.783.5038
Morehead State University 100 Admission Center Morehead, KY 40351
admissions@moreheadstate.edu
© Copyright 2012 Morehead State University - 150 University Blvd. Morehead, KY 40351 • 1.800.585.6781 MSU is an affirmative action, equal opportunity, educational institution.