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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

July 18th, 2008
November 8th, 2008
April 25th, 2009
None of the above

Number of additional guests:      Guest names:

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

I plan to attend the following Mines Info Night Program:
North Dakota - Bismarck Wednesday, November 19, 2008
6:30 - 8:00 pm		 Hampton Inn
1440 Mapleton Ave, Bismarck, ND
South Dakota - Pierre Thursday, November 20, 2008
5:30 - 7:30 pm		 Pizza Ranch
321 E Huston Ave, Ft. Pierre, SD
Nebraska - Lincoln Thursday, December 4, 2008
6:00 - 7:30 pm		 Valentino's
2701 South 70th St., Lincoln, NE
Colorado - Denver Tuesday, December 9, 2008
6:00 - 7:30 pm		 Beau Jo's Pizza
2710 S Colorado Blvd, Denver, CO
Colorado - Fort Collins Wednesday, December 10, 2008
6:00 - 7:30 pm		 Woody's Wood Fired Pizza
518 West Laurel, Fort Collins, CO
South Dakota - Sioux Falls Wednesday, December 10, 2008
5:30 - 7:30 pm		 Pizza Ranch
41st & Kiwanis, Sioux Falls, SD
Minnesota - Minneapolis Thursday, December 11, 2008
6:30 - 8:00 pm		 Hampton Inn
7745 Elm Creek Blvd., Maple Grove, MN
Nebraska - Omaha Thursday, December 11, 2008
6:30 - 8:00 pm		 Valentino's
5022 S 108th St., Omaha, NE
Wyoming - Gillette Thursday, December 11, 2008
5:30 - 7:00 pm		 Godfather's Pizza
501 W Lakeway Rd, Gillette, WY
None of the above    

Number of additional guests:      Guest names:
 
Campus Visit Request:
We would enjoy having the opportunity to show you our beautiful campus.  From May 12th - August 15th campus visits are scheduled Monday - Friday at 9:30am.  If you would like to schedule a campus visit, please indicate the date.  An afternoon tour at 1:30pm could be scheduled if the morning tour is not possible.  However, one week notice would be required to ensure that professors will be available.  Please contact the Admissions Office to request an alternative time. When classes are not in session counselors are available for visits but faculty and coaches may not be available, please call for an appointment.
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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