Missouri Southern has a one-time, non-refundable application fee. This fee is $15.00 for FIRST-TIME applicants and $50.00 for international applications. Please print, complete, and fax or mail this form to Missouri Southern's Admission Office at: Admissions Office Student's Social Security Number _____________ Student's First Name _______________________ Student's Middle Initial _____________________ Student's Last Name _______________________ Student's Phone Number ____________________ Has student completed online application form? _____ yes _____ no If so, on what date was application completed? ____________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Please circle one: Visa Mastercard Credit Card Number _______________________ Name on Credit Card _______________________ Cardholders Address _______________________ Cardholders City/State/Zip ___________________ Cardholders Phone ________________________ Expiration Date ____________________________ V Code (3 digit code on the back of the card) ________ Cardholder's Signature ______________________ To return to your application page please hit your browser's BACK button OR |