Information Request Form

Information Request Form

Please complete this form to receive information about the programs offered by Minnesota State University Moorhead.  You will receive this information via regular mail.  If you have specific questions, please call us at 1.800.593.7246.

Please provide the following contact information:

(* Indicates required field.)

* 

First Name:

   Middle Initial:
* 

Last Name:

* Have you contacted us previously or received information from us? 
                           Yes           No

Mailing Address:

* Street Address
Address (cont.)
* City
* State/Province
* Zip/Postal Code
Country
Work Phone
* Home Phone
(999)999-9999
E-mail Address

Please select one of the following:

New student (high school)
Transfer student
Graduate student
 

High School Information:

* High School Grad Year 
  (completed or expected)
* High School Name

* I am interested in beginning my studies at MSU Moorhead (select one)

Fall     Spring      Summer       Year: 

Program Interested In:

Transfer Students Please Complete:

College Currently Attending or most recent college attended
Permanent Address
Street Address
Address (cont)
City
State
Zip
Country
Phone

Where did you hear about us?

Additional Comments: