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Mount Marty College
Application for Admission Yankton Campus
Yankton Admisson Form
PERSONAL DATA
Your First Name:
Middle Name:
Last Name:
Preferred Name:
Former Name[s]:
Social Security Number:
Permanent Address:
City:
State:
Zip:
Country:
Current Address:
City:
State:
Zip:
Country
Phone Number:
Cell Phone Number:
E-mail Address:
Facebook Username (e.g. www.facebook.com/Jane.Doe)
How would you prefer to be contacted?
Phone Cell Phone Mail Email Text
ENROLLMENT DATA
Term of Attendance:   Year
Degree Sought:
Entering Status:
Intended Load:
Financial Assistance:
Residency Status:
What influenced you to apply to Mount Marty College?


ACADEMIC DATA
Please select up to three program areas of interest in order of preference.


PERSONAL DATA
Please note: This information is optional and will not affect any admission decision. It is used for institutional research and reporting only.
Marital Status: Gender: Male Female
Date of Birth:
Religious Preference
 
Citizenship: U.S. Citizen   Permanent Resident   Foreign Student
If Not a US Citizen or Permanent Resident, name country of citizenship:
Occupation:
Place of Employment:
 
Ethnicity:
Non-Hispanic-Latino
Hispanic-Latino
Race:
Are you a first-generation college student (i.e. parents didnt attend college):
FAMILY DATA
Parent/Guardian
First Name:
Last Name:
Relationship to you:
Other:
Parent Email Address(es):
or
Mailing Address (If Different than yours):
Address:
City:
State:
Zip:
Occupation:
Employer:
Parent/Guardian
First Name:
Last Name:
Relationship to you:
Other:
 
Parent Email Address(es):
or
Mailing Address (If Different than yours):
Address:
City:
State:
Zip:
Occupation:
Employer:
 
Send Information to:
Siblings (include name & grade level):
Spouse's Name:
Children:
List of family members who have attended Mount Marty College and their relationship to you:
EDUCATIONAL DATA
Please list the high school from which you have, or will, graduate:
Name of High School

City

State

Dates Attended

Graduation Date

 Have you received, or will you receive, any of the following prior to your enrollment?
General Education Development(GED) Certificate:
Scores through ACT or SAT testing:
College Credit through dual-credit coursework:
College Credit through Advance Placement (AP) exam(s):
College Credit through College Level Exam Program (CLEP) testing:
College Credit through military training:
Please list post-secondary institutions attended, beginning with the most recent:
Name of Institution

City

State

Dates Attended

Graduation Date

















EXTRA-CURRICULAR DATA
Have you been contacted by a MMC Athletic Coach or Activity Advisor? Yes No
Which sports are you interested in participating in college?







Which activities are you interested in participating in college?



Please list any activities, either in or out of school, in which you participate(d). You may include volunteer activities, specific events, accomplishments, leadership experiences, musical or theatre involvement, athletic achievements, etc. Please indicate whether or not you hope to pursue these activities in college.
Activities Years of
Participation
Positions held, honors won,
letters earned, etc.
Would you like to
participate in college?
COLLEGE PLANNING DATA
How do you think a college education will help you fulfill your future goals and why would you like to attend Mount Marty?

Including MMC, please list the colleges you are considering in order of preference.
First Choice:
Second Choice:
Third Choice:
Fourth Choice:
DISABILITY ACCOMMODATIONS
Accommodations are provided in accordance with Section 504 of the Rehabilitation act of 1973 and the Americans with Disabilities Act of 1990 for eligible students upon request. Eligible students must provide documentation that appropriately substantiates the need for requested accommodations. If you need accommodations, please contact the Disabilities Services Office at 668-1518. Forms and information on the accommodations web process can also be found on the Disabilities Services webpage under Student Life.
CONFIRM AND SUBMIT
I realize this application becomes a part of my permanent record at Mount Marty College. Having completed this application to the best of my ability, I hereby request admission to Mount Marty College. By submitting this application, you are confirming that the information contained on this application is correct, complete, and honestly represented. Mount Marty College specifically prohibits discrimination in its policies and practices against any individual for reason of race, color, creed, age, national or ethnic origin, handicap, disability or gender.
Send Required Materials To: Mount Marty College
Admissions Office
1105 W 8th Street
Yankton, South Dakota 57078
 
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