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*:
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:
By submitting this application, you are certifying that all statements in this application are complete and true.