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  • SMART Program Application

Office of Diversity & Inclusion

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  • 2015 S.M.A.R.T. Program Application

    Name:
    Address:
    City:
    State:
    Zip Code:
    Home Phone: XXX-XXX-XXXX
    Mobile Phone: XXX-XXX-XXXX
    Parent's/Guardian's Name(s):
    Email:
    Date of Birth: (mm/dd/yyyy)
    Have you been admitted to MSU Moorhead?
                  

    List intended major (if known) or undeclared:
    Have you completed the 2013 FAFSA?
                   

    Gender:
      

    Ethnicity (check all that apply):
                  
    List any disabilities or special needs:


    Submit or Return this application by May 1, 2015.

    • A phone interview will be scheduled with the Office of Diversity and Inclusion.
    • The program is limited to 35 participants
    • Considerable emphasis will be placed on the interview.
    • Students will be notified by July 1, 2014

    For more information please contact:
    Diversity and Inclusion
    MSUM Box 133 | 1104 7th Avenue South
    Moorhead, MN 56563
    Phone: 218.477.2652 | Email: diversity@mnstate.edu