New Student Application

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

Student Classification

Campus

Entrance Level

Undergraduate
Graduate

US Citizen

Yes 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

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?

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 tribe	Yes No Not Selected
Which Tribe?	If Yes

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

Signed
Date


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