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Name         
                                      (First)                               (MI)                        (Last)     (Preferred First)
Address   Birth Date
City State      Zip Code
Phone Email 
Cell Phone IM Address
High School    HS Graduation Year HS GPA
ACT Composite ACT Math SAT Combined SAT Math
Gender (optional)  Male     Female  
Ethnicity (optional) American Indian or Alaskan Native Hispanic
  Asian or Pacific Islander White, not of Hispanic origin
  Black, not of Hispanic origin Other
College(s) attended
I plan to enroll  
My family attended SDSM&T Mother Father Grandparent
  Sister Brother Aunt/Uncle
Rank your interest in SDSM&T Top Choice Top 3 School Somewhat interested
Have you applied to SDSM&T Yes    No  
Have you been admitted Yes     No  
Parent Information:
Parent Name Email Phone
Parent Name Email Phone
Area of Interest/Major: Student Life
Primary Program Choice

Secondary Program Choice
Intercollegiate Sports
    
Clubs and Organizations
Academic Organizations
Greek Organizations		 Honor Societies
Multicultural Organizations
Student Government
Visual and Performing Arts
 
I plan to attend the following Campus Visit Programs:

Visit Mines Day

April 17, 2010
None of the above

Which department open house would you like to attend during Visit Mines?
     

Number of additional guests:      Guest names:

Do you require any special assistance during your visit:  Yes     No    

Campus Visit Request:
Date of Visit:   Start Time:  9:30 am   1:30 pm    
Number of additional guests:    
Academic department you would like to visit:
Athletic coach you would like to meet with:
Music department you would like to meet with: 
Do you require any special assistance during your visit:  Yes     No    
Other Comments or Information Requests:



 

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