Non-Degree Graduate Application

Non-degree seeking graduate students who are taking a Mansfield University course for the first time must complete this application/registration form.

A one-time non-refundable/non-transferable application fee of $25 is required. Please refer to the Graduate Admissions website for additional requirements or call 570-662-4806. Please send any additionally required application materials to:

Graduate Admissions Office
G27 South Hall
71 South Academy St.
Mansfield University
Mansfield, PA 16933


Student Information

*Student Last Name:     *First Name:     M.I.:     Previous Name:

*Gender: Male Female      *Date of Birth:

Social Security No. : (xxx-xx-xxxx)
The Federal Privacy Act of 1974 requires that you be notified that disclosure of your Social Security Number is voluntary and is not required to determine admission. Your Social Security Number will be used to match your application with your SAT/ACT Test Scores and/or Financial Aid information so failure to provide it may affect your eligibility for financial aid and may delay decision of admission. Your Social Security number is also used to report your educational expenses to the Internal Revenue Service to verify any education-related deductions you may claim on your federal income taxes.

*Area Code/Home Phone: (xxx-xxx-xxxx)    Work Phone:    Cell Phone Number: (xxx-xxx-xxxx)


*Permanent Address:

*City:   *State:   *Zip Code:



*Email Address: 


Local Mailing Address (if different from above):


City:  State: Zip Code:

Veteran Information

*Are you a veteran?   Yes   No

  Branch of Service:   Date of Service

Citizenship Information

*Are you a United States Citizen?: Yes   No

  If no, what is your visa status?

Bachelor's Information

Bachelor's Degree:   Date Received:

Institution Name:

Institution Street Address:

City:   State:   Zip:

List the names of all institutions you have attended in order of attendance:

Have you previously received a Master's Degree? Yes   No

Enrollment Information

*Semester in which you wish to enroll

Course Registration

For course information, please access Academic Records:


Enter Session, Course Prefix, Course Number, Course Title, Course Meeting Times, Course Credits
(Example: IA-ED 5500 190, Mtds & Mlts Research, online, 3 credits) :

Ethnic/Racial Identification (optional)

We ask each applicant to provide information about his/her ethnic & racial background. We use this information solely to help us in determining whether the university is being successful in its efforts to assure equal opportunities to all persons. Please select the appropriate ethnic & racial identification below:

What is your ethnicity?
Hispanic or Latino
Not Hispanic or Latino

What is your race? Mark one or more races to indicate what you consider yourself to be:
American Indian or Alaska Native
Native Hawaiian or Pacific Islander
Black or African American


Where did you hear about Mansfield University or this program?

Admissions Counselor
College Search Website, i.e. College Board, Hobsons, etc.
Mansfield University Web site
Teacher/Guidance Counselor
Web search

Other (please list)


Questions or Comments, Contact Graduate Admissions or call 1-800-577-6826.