Admissions

SSN            

First Name  

Middle Initial

Last Name   

 I am requesting Missouri Residency for: (select one) Fall   Spring  Summer 

Year

Date of Birth     

Email Address    

Phone             

Permanent Address:

 
City                 
State              
Zip Code          

County              Adair Andrew Atchison Audrain Barry Barton Bates Benton Bollinger Boone Buchanan Butler Caldwell Callaway Camden Cape Giradeau Carroll Carter Cass Cedar Chariton Christian Clark Clay Clinton Cole Cooper Crawford Dade Dallas Davies Dekalb Dent Douglas Dunkin Franklin Gasconade Gentry Greene Grundy Harrison Henry Hickory Holt Howard Howell Iron Jackson Jasper Jefferson Johnson Knox Laclede Lafayette Lawrence Lewis Lincoln Linn Livingston McDonald Macon Madison Maries Marion Mercer Miller Mississippi Moniteau Monroe Montgomery Morgan New Madrid Newton Nodaway Oregon Osage Ozark Pemiscot Perry Pettis Phelps Pike Platte Polk Pulaski Putnam Ralls Randolph Ray Reynolds Ripley St. Charles St. Clair St. Francis St. Genevieve St. Louis Saline Schuyler Scotland Scott Shannan Shelby Stoddard Stone Sullivan Taney Texas Vernon Warren Washington Wayne Webster Worth Wright City of St. Louis Other  

How long at this address?    

Current Address:         
City    
State   
Zip Code      

County                      Adair Andrew Atchison Audrain Barry Barton Bates Benton Bollinger Boone Buchanan Butler Caldwell Callaway Camden Cape Giradeau Carroll Carter Cass Cedar Chariton Christian Clark Clay Clinton Cole Cooper Crawford Dade Dallas Davies Dekalb Dent Douglas Dunkin Franklin Gasconade Gentry Greene Grundy Harrison Henry Hickory Holt Howard Howell Iron Jackson Jasper Jefferson Johnson Knox Laclede Lafayette Lawrence Lewis Lincoln Linn Livingston McDonald Macon Madison Maries Marion Mercer Miller Mississippi Moniteau Monroe Montgomery Morgan New Madrid Newton Nodaway Oregon Osage Ozark Pemiscot Perry Pettis Phelps Pike Platte Polk Pulaski Putnam Ralls Randolph Ray Reynolds Ripley St. Charles St. Clair St. Francis St. Genevieve St. Louis Saline Schuyler Scotland Scott Shannan Shelby Stoddard Stone Sullivan Taney Texas Vernon Warren Washington Wayne Webster Worth Wright City of St. Louis Other  

Please list any other mailing addresses in the previous 24 months

   Date

   Date

Why do you reside in Missouri and what are your plans after completion of MSSU coursework?

 1. Date of Birth (if you are under 21, please go on to question 3)

 2. Do your parents/guardian or spouse claim you as a dependent for tax purposes? Yes  No  (if no, please go to question 4)

 3. If your parents/guardian/spouse claim you as a dependent, you may qualify for classification as a Missouri resident IF your parents/guardian/spouse meets either of the following criteria:

         Presence within the State of Missouri for a period of twelve (12) months;

OR

         Presence within the State of Missouri for the purposes of retirement, full-time employment, professional practice or to conduct business full time.

If you are unable to select either of the categories above, we are unable to change your residency status at this time.

 If you are able to select one of the categories in question 3, we will need the following documentation from your parent/guardian/spouse to be sent to our office:

• Documentation of residing in Missouri during the past 12 months (copy of lease or purchase agreement needed)

• A copy of: Missouri Driver's license, Missouri registration for vehicles owned, voter registration card,  Missouri property tax receipt, Missouri income tax statements.

• We will need documentation of retirement OR employment verification (showing date of employment and whether it is full time or part time) OR starting a practice or business  OR marriage license.

• Other documentation that supports your claim.

4. If you are over 21 years of age or a student under twenty-one (21) years of age who through marriage, formal court action  or abandonment are their own legal guardian, then you may qualify for classification as a Missouri resident IF you or your spouse (if applicable) meet either of the following criteria:

         Presence within the State of Missouri for a period of twelve (12) months;

OR

         Presence within the State of Missouri for the purposes of retirement, full-time employment, professional practice or to conduct business full time.

If you are unable to select either of the categories above, we are unable to change your residency status at this time.

If you are able to select one of the categories in question 4, we will need the following documentation from your parent/guardian/spouse to be sent to our office:

• Documentation of residing in Missouri during the past 12 months (copy of lease or purchase agreement needed)

• A copy of: Missouri Driver's license, Missouri registration for vehicles owned, voter registration card,  Missouri property tax receipt, Missouri income tax statements.

• We will need documentation of retirement OR employment verification (showing date of employment and whether it is full time or part time) OR starting a practice or business  OR marriage license.

• Other documentation that supports your claim.

I affirm/attest that the information and documentation I have provided is true and accurate to be best of my knowledge.  I understand that submitting falsified information could result in my suspension from the University with NO REFUND of fees.

Full Name Date   

Please submit required documentation before the end of late registration for the term in question to:

Admission Office
Missouri Southern State University 
3950 E. Newman Road
Joplin, MO 64801