When All Else Fails

Application for Admission

Registrar’s Office 4975 Hwy 51 North P.O. Box 7047 Senatobia, MS 38668

Social Security Number: ______________________ Phone Number: _____________________________ E-mail:_____________________________________________________@________________________________________

*Non-degree seeking students are not eligible for financial aid.

Intended Major: __________________________ Major Code: _____________ Degree Seeking / Non-degree Seeking*

(See reverse for codes) (mark one)

Personal information

Last

Senatobia

DeSoto Oxford Online Ashland

Name:________________________________________________________________________________________________

First Street if different from physical Street or P.O. Box City City Middle State State Zip Zip Maiden County County

PhysicalAddress:______________________________________________________________________________________ MailingAddress:______________________________________________________________________________________ Date of Birth: _____________ Gender:

Male Female

City/State/Country of Birth: _______________________ MS Resident?

Yes

Yes No

Race/Ethnicity: Are you Hispanic/Latino? What is your race? (You may choose more than one)

Yes No

No

U.S.Citizen?

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander

Family Information Choose One: Parent

**If you choose guardian, you must mail in official guardianship documents.

Guardian**

Street or P.O. Box

Spouse

Name: ______________________________________________

Last City State Zip First

Mailing Address: ___________________________________________________________________________________ High School information If any of your transcripts are from out of state, you must provide proof of residency. Official high school transcript or GED and ACT scores (see NWCC catalog for exceptions) are required for admission to be complete....