UNDERGRADUATE-GRADUATE ADMISSION APPLICATION
CAMPUS SITE: Ihanktonwan Community College


New Student Application
General Information

Entrance LevelUndergraduate
Graduate

Student Classification
Campus
First Name
Middle Name
Last Name
SSN
Street
City
State/Province
Zip/Postcode
Country
Home Phone
Cell Phone
Work Phone
Email
Birth Date
Gender Male Female
Marital Status
Ethnicity
US CitizenYes    No    Not Selected
Are you a member of a Federally Recognized Tribe?Yes    No    Not Selected
Tribe/Agency Location
Do you require services for a disability?Yes    No    Not Selected
Are you a first generation student?Yes    No    Not Selected
(Do your parents have a four year college degree?)
Are you a single parent?Yes    No    Not Selected
Are you eligible for Veteran's Benefits?Yes    No    Not Selected
Program
Enroll in


Emergency Contact Information

Contact Name
Relationship
Home Phone
Work Phone
Cell Phone


Education Data

Do you have a High School Diploma?Yes    No    Not Selected
Graduation Date
Do you have a GED?Yes    No    Not Selected
Date of completion
Colleges/Universities attended: Name 1
Location
Dates of attendance
Degree Earned
Colleges/Universities attended: Name 2
Location
Dates of attendance
Degree Earned
Colleges/Universities attended: Name 3
Location
Dates of attendance
Degree Earned
Are any of these credits being transferred to Sinte Gleska University?Yes    No    Not Selected
If yes, please request an official transcript from each institution.
Major
(All students must declare a major, please indicate one only)
Is English your Primary Language?Yes    No    Not Selected
Are you a bilingual speaker?Yes    No    Not Selected
What languages?

Family Data

Mother's Full Name
Is your mother enrolled in a Federally recognized tribe?Yes    No    Not Selected
Which Tribe?
If Yes
Father's Full Name
Is your father enrolled in a Federally recognized tribeYes    No    Not Selected
Which Tribe?
If Yes

Resident Status

Do you reside on a reservation?Yes    No    Not Selected
Are you a resident of South Dakota?Yes    No    Not Selected
If not, which state?

Employment Data

Employment Status
Do you consider yourself to be low income?Yes    No    Not Selected

Signature

Signed
Date


To the best of my knowledge, the information provided on this application is true and correct.


Enter the above code
 Required




SINTE GLESKA UNIVERSITY
REGISTRAR’S OFFICE
PO BOX 105
MISSION, SOUTH DAKOTA 57555-0105
605-856-8100
www.sinte.edu