Office of Records and Registration

Office of Records and Registration

Registration - Non-Degree Seeking (Special) Students

* Required Field

Name

First *
Middle
Last *
Previous
Check here to submit an international address Note: You can enter both International and non International addresses.

Current USA/Territories/Canadian Address

Address Line 1 *
Address Line 2
City *
State *
Zip (5 Digit - example: 56301) *
County (example: Stearns)

Permanent U.S.A. / Territories / Canada Address (if different)

Address Line 1
Address Line 2
City
State
Zip
County (example: Stearns)

U.S.A. / Territories / Canada Phone Number

Home ( ) -
Cell ( ) -
E-mail Address *

Citizen/Resident

  *

 
Resident of which state?   Years:   Months:  
 
 

Emergency Contact

Name
Phone ( ) -

I wish to register for SCSU courses because I seek:

*



I wish to begin classes: Year (yyyy) *  
*

Educational Experience: *
Year Received  
Institution
City  
State  
Country  

Do you hold a Baccalaureate degree? *
If yes, Institution
City
State
Country

Do you hold a Masters degree? *
If yes, Institution
City
State
Country

Have you attended SCSU before? *
Last attendance: Semester Year

Have you submitted an application for undergraduate admission?
Semester Year

Have you submitted an application for graduate admission?
Semester Year

Please see statement regarding confidential information below.

Birthdate: mm dd yyyy
(necessary for establishment in the registration system)

SSN: - -

Gender:

Are you Hispanic or Latino (a person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture, regardless of race)?

Racial background: (select any that apply)





Signature required by all special students (non-degree seeking)
*
**Note: You must sign your request by entering your name and date below.

Signature * Date * (mm/dd/yyyy)  

Confidential Information

Welcome and thank you for your interest in St. Cloud State University. It is important for you to be aware of the following data privacy issues before submitting this form.

The University is asking you to provide information that includes private and/or confidential information under state and federal law. The University is asking for this information in order to process your request.

You are not legally required to provide the information the University is requesting; however, the University may not be able to effectively process your request if you do not provide sufficient information. With some exceptions, unless you consent to further release of private information, access to this information will be limited to school officials, including faculty, who have legitimate educational interests in the information. Under certain circumstances, federal and state laws authorize release of private information without your consent:

  • To other schools in which you seek or intend to enroll, or are enrolled, if you are first notified of the release;
  • To federal, state or local officials for purposes of program compliance, audit or evaluation;
  • As appropriate in connection with your application for, or receipt of, financial aid;
  • To your parents, if your parents claim you as a dependent student for tax purposes;
  • If the information is sought with a subpoena, court order, or otherwise permitted by other state or federal law, and
  • To an institution engaged in educational research or accrediting agency.

SCSU abides by the provisions of the Title 9 federal and state legislation forbidding discrimination on the basis of sex, race, color, gender, religion, marital status, creed, status with regard to public assistance, membership/activity in a local commission, status as a Vietnam-era veteran, age, ancestry, disability, national origin, sexual orientation, or citizenship. This document can be made available in formats such as large print or cassette tape, upon request.

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