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  • SMART Program Application

Office of Diversity & Inclusion

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  • 2017 S.M.A.R.T. Start Program Application

    Legal Name:

    Dragon Student ID Number:
    XXX-XXX-XXXX
    Date of Birth: (mm/dd/yyyy) 
    Parent/Guardian Name(s):
    Parent/Guardian Phone: XXX-XXX-XXXX
    T-shirt Size:
               
    Have you completed the 2017-2018 FAFSA?
               
    What is your gender identity?:
    What is your preferred pronoun(s)?

    Please select which populations you identify with (check all that apply):

     
    Please list any needed accommodations, allergies, or dietary restrictions:
     

    Submit or Return this application by June 30, 2017.

    The program is limited to 30 students.

     

    For more information please contact:
    Office of Diversity and Inclusion

    Minnesota State University Moorhead
    Box 133 | 1104 7th Avenue South
    Moorhead, MN 56563
    Phone: 218.477.2652 | Email: diversity@mnstate.edu