Worldwide Learning Application for Admission


NOTE: The application below is for students seeking a distance degree from Mayville State. If you are interested in taking Mayville State classes without seeking a Mayville State degree, use your "Back" button to return to the Online & Distance Learning page and click on "Register for Worldwide Learning courses as a new or returning student." If you are interested in an on-campus degree from Mayville State go to the How to Apply Page

NOTE: To pursue a distance degree at Mayville State, you must be either a U.S. Citizen of a resident of the U.S. with an alien registration number.



Have you ever applied for admission to Mayville State?   Yes      No
Have you ever taken a course at Mayville State?   Yes      No
If yes, list date last attended (e.g. 05/15/2001):
Will you be registering for courses from another North Dakota University System institution?   Yes      No
Legal Last Name:
Legal First Name:
Middle Name:
Former Last Name (if applicable):
Social Security Number or National ID**:
** Disclosure of your Social Security Number is voluntary. Social Security Numbers are used a an Individual ID number for record keeping and administrative purposes. Failure to provide a SSN may cause delays in administrative services such as financial aid processing.
Birth Date (e.g. 06/15/1985):
Place of Birth - City: State: County: Country (if not USA):
Are you a U.S. citizen?   Yes      No
If no, in which country do you hold citizenship?
If not a U.S. citizen, are you a permanent resident?   Yes      No
If yes, give alien registration number?
Gender*:
Are you Hispanic/Latino?*   Yes      No
Race*:
If other, explain?
* NOTE: This information is requested for statistical purposes only and will not affect the status of your application. The information will not be used in a discriminatory manner and your response is voluntary.
Your Email Address:*
Alternate Email Address:
Mailing Address:
City:
State/Province:
Zip Code:
County:
Country:
Your Primary Phone (e.g. 701-555-5555):*
Name of Parent or Guardian:
Permanent or Parent/Guardian Address (if different from above):
City:
State/Province:
Zip Code:
County:
Country:
Permanent or Parent/Guardian Phone (e.g. 701-555-5555):
Are you a member or veteran of the Armed Services?   Yes      No
If yes, will you apply for benefits??   Yes      No
Are you an active member or dependent of an active member of the military stationed in N.D.?   Yes      No
Are you a spouse or dependent of a graduate of a North Dakota Public Institution of Higher Education?   Yes      No
If yes, which institution?
Are you a North Dakota resident?   Yes      No
If yes, length of residency?
If no, state of residency?
When do you plan to begin classes at Mayville State?
Worldwide Learning Program you are applying for:
Indicate the date you took or plan to take either the ACT or SAT (mo./year e.g. 06/2004): ACT:    SAT:
List the last high school you attended:
School:   City:   State:   Graduation Date:  
GED (high school equivalency exam) Completion Date:  
List all colleges, universities, and schools (beyond high school) attended, whether or not credit was earned:
Failure to list all colleges, universities, and schools previously attended may result in denial of admission, recision of admission, dismissal, loss of credit, or other appropriate sanctions.
1. School:   City:   State:  
  Date Started:   Date Ended:   Degree Earned:  

2. School:   City:   State:  
  Date Started:   Date Ended:   Degree Earned:  

3. School:   City:   State:  
  Date Started:   Date Ended:   Degree Earned:  

4. School:   City:   State:  
  Date Started:   Date Ended:   Degree Earned:  

5. School:   City:   State:  
  Date Started:   Date Ended:   Degree Earned:  

If you have not completed the college prepatory course requirements, or if you do not meet other admission criteria, you may request that the decision on your application for admission take into account the following:
 
College Preparatory Courses
 
If you are applying for admission to one of the four-year public universities in North Dakota, which include: Dickinson State University, Mayville State University, Minot State University, North Dakota State University, University of North Dakota and Valley City State University please answer the following question. (Applicants who have graduated from high school prior to 1993 or are transfer applicants with 24 or more transferable credits are excluded).
After your high school graduation, will you have completed the minimum number of College Preparatory courses required of freshman applicants including: four units of English; three units of Math (Algebra I or above); three units of Lab Science (at least one unit in two or more of biology, chemistry, physics, or physical science); three units of Social Science (exclude consumer education, cooperative marketing, orientation to social science, and marriage/family)?   Yes      No
 
Additional Information Required
 
All students making application effective fall 2009, must answer the following questions. An affirmative response to any of these questions will not automatically prevent admission, but you will be asked to provide additional information. The information will be reviewed by a campus officer or committee charged with that responsibility. Falsification or omission of information may result in a denial of admission, rescission of admission, dismissal, or other appropriate sanction.
1) Have you ever pled guilty (or no contest) to or been convicted of any felony?   Yes      No
2) Within the past 10 years, have you pled guilty (or no contest) to or otherwise been convicted of a misdemeanor crime involving violence or the threat of violence in any court? (“Crime of violence” means an offense in which physical force was used, attempted or threatened against the person or property of another or by the nature of the offense it involves substantial risk that physical force may be used against a person or property of another. Examples of crimes of violence include, but are not limited to, abuse, arson, assault (including sexual assault or domestic violence), battery, breaking and entering, burglary, criminal mischief or vandalism, harassment, homicide, menacing, reckless endangerment, stalking, terrorizing and unlawful restraint or imprisonment).   Yes      No
3) Are you currently required to register as a sex offender in any state?   Yes      No
4) Have you been dismissed or suspended from a college or university for disciplinary reasons within the last 5 years (“Dismissed for disciplinary reasons” means a permanent separation from an institution due to conduct or behavior. “Suspended for disciplinary reasons” means a sanction imposed for disciplinary reasons that results in a student leaving school for a fixed period but not permanently).   Yes      No
Go to http://www.ndus.nodak.edu/uploads/ndus-policies/P5II.pdf to view the list of NDUS academic programs which require further criminal history background checks. These may include nationwide FBI criminal history background checks or a criminal history background check which may be a North Dakota BCI check, nationwide check or check of another state or multiple jurisdictions.
 
Electronic Signature
 
I understand the information presented on both sides of this form will be used in evaluating my application for admission to a North Dakota University System Institution. I certify that all statements are complete and true as of this date. If this information changes, I will notify the Admission/Enrollment Services Office of the changes and understand that my admission status will be reevaluated at that time.
Signature:   Date: