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Student Support Services Application

Student Support Services Application



Application for Freshman Undergraduate Admissions

Personal Information

 
Last name:   
 
First name:     
 
Middle name:    
 
Date of birth (MM/DD/YYYY)    
 
Banner ID @ 
(if you don’t have a banner id insert: N/A)
 
Gender       Male     Female
 
Citizenship       U.S. Citizen       Permanent Resident


Ethnicity

Please indicate how you identify yourself (select one or more):

American Indian or Alaska Native                                 Asian

Black/African American                                                 Hispanic or Latino                                                                             
Native Hawaiian or Other Pacific Islander                     White

Other (define ) 


Contact Information

Permanent Address:            City: 

 
 State:                           Zip        
 
Local address:              City: 
 
 State:                           Zip        
 
Mailing address and permanent address are the same.
 
Cell phone                   Home phone     
 
Work phone     
 
Best time to reach you     
 
Personal e-mail:      

Parent Information

Parent(s)/Guardian(s) Name(s):     
 
Phone     
 
Parents address:              City: 
 
 State:                           Zip        
 
Do either of your parents or guardian have a bachelor’s degree(four years)?     Yes    No
 
Do your parent’s claim you as a dependent for income tax purposes?     Yes    No
 
Emergency contact number:     

Educational Information

High school attended:  

City:                     State:  

Date of graduation or when GED was taken:(MM/DD/YYYY)   


Previous colleges or universities attended:

List all colleges/universities attended, if any. Please begin with the most recent and have official transcripts sent from each.
 
College level check one

Freshman       Sophomore        Junior

Senior             Transfer        number of credits
 
Are you a first semester freshman at NMHU?    Yes    No
 
Do you plan to pursue a Bachelor’s Degree at NMHU?    Yes    No
 
Do you plan to transfer to another College or university?    Yes    No

If yes, Where    
 
Do you have a physical or learning disability?    Yes    No
 

This information is true
I certify all the information provided, including financial and family documentation, in conjunction with this application is true and correct to the best of my knowledge. I give permission to release my name to provide recognition in the Student Support Services Newsletter and other publication. I authorize Student Support Services Program to have access to my school records for program purpose and understand that these records will be held in strict confidence.
 
New Mexico Highlands University and TRIO Student Support Services provides educational and employment opportunities to qualified persons without discriminatory regard to race, sex, disability, age, marital status, religion, color, ethnic and national origin, sexual orientation, no-merit factors. If you are an individual who is in need of auxiliary aid or services in order to participate in our program please contact the university at 505-425-7511.

Box 9000, Las Vegas, NM 87701      Facebook Twitter Youtube Portrait