* indicates a required field.
* First: Middle:
* Street address:
City: State: * Zip:
* Home phone:
(and/or) * Cell phone:
* Email address:
* Date of birth (00/00/0000): Month: Day: Year:
* Social Security Number:
* Gender: MaleFemale
* Race: American Indian/Alaskan NativeAsian/Pacific IslanderHispanicBlack (non-Hispanic)White/Anglo/CaucasianOther
* Specify Other:
* Current occupation (Enter NA if none):
* Employer (Enter NA if none):
* Business phone (Enter NA if none):
* In case of emergency notify: * Phone:
* Last high school attended:
* Graduation year (Enter NA if none)
Are you eligible to return to the last institution at which you were enrolled as a full-time student?
Approximate GPA on all college work attempted:
Have you ever attended Millsaps College?
List academic courses you wish to pursue:
Please check any of the following that apply:
I am taking courses for teacher certification
I am taking preparatory course work necessary to enroll in undergraduate program or graduate/professional program.
I apply for admission as a non-degree student to take undergraduate courses for the
The information provided above is correct to the best of my knowledge. I understand admission based on this application is to a non-degree program.
You must write out the words that appear in the window below in order to complete your form process.
Tips: If you can't see the words clearly, re-load the image. Words are case-sensitive.