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

*Required

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:

County:

 

*Email Address: 

 

Local Mailing Address (if different from above):

Street:

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
Asian
Native Hawaiian or Pacific Islander
Black or African American
White

 

Where did you hear about Mansfield University or this program?

Admissions Counselor
Billboard
College Search Website, i.e. College Board, Hobsons, etc.
Facebook
Friend
Magazine
Mansfield University Web site
Newspaper
Relative
Radio
Teacher/Guidance Counselor
TV
Web search

Other (please list)

 

European Union General Data Protection Regulations Policy

CONSENT FOR THE COLLECTION AND PROCESSING OF SENSITIVE OR PERSONAL DATA
FROM THE EUROPEAN UNION FOR ADMISSION AND ENROLLMENT PURPOSES

  1. Pursuant to the European Union General Data Protection Regulation (EU GDPR), the Pennsylvania State System of Higher Education and its member universities, including Mansfield University of Pennsylvania, in its capacity as a data controller under the EU GDPR, must obtain explicit, affirmative consent before it can collect or process any sensitive or personal data for a lawful basis including for admission and enrollment purposes.
     
  2. Sensitive data includes data revealing racial or ethnic origin; political opinions; religious or philosophical beliefs; trade union membership; genetic or biometric data; health data; or data concerning a person's sex life or sexual orientation.
     
  3. Any sensitive or personal data that is collected will be for the sole purpose of application for admission to the University that is sent from the EU and is necessary for that purpose or for any purpose permitting the use of sensitive or personal data under applicable law or to meet other compliance obligations of the University.
     
  4. I understand that any sensitive or personal data that is collected will also be used to report serious illness, injury, or other health or emergency situations involving me, as well as to address or report discrimination, harassment, sexual or gender-based misconduct and criminal behavior which may be committed by or against me or otherwise involve me, on or off campus, to appropriate authorities including staff, faculty, and administrators of the University or appropriate legal or governmental authorities under applicable policies of the Pennsylvania State System of Higher Education or the University (including but not limited to applicable codes of conduct) and applicable laws (including but not limited to Title IX and the Clery Act).
     
  5. I understand that refusal to consent to the use of sensitive or personal data, and the transfer of sensitive or personal data overseas, for the purpose outlined in this notice may make it impossible for the University to carry out necessary activities, and may preclude the University's ability to provide requested services.
     
  6. I understand I have the right to withdraw consent to the collection and processing of sensitive or personal data and to do so, I must contact the GDPR compliance officer at jcosgrov@mansfield.edu.  I also understand that the complete deletion of data will not be feasible in all situations to ensure the University's ability to comply with regulatory requirements.

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