Student input form

New Student Registration

First Name

Middle Name

Last Name

Email Address

Please select current or highest level of education completed

Which semester are you registering for?

Have you been admitted to a program for the term you want to register for?

Yes

No

As an admitted student, you should register online.

What are my plans?

I have applied to a program

I am taking classes before applying

I am taking classes for professional development

Which program have you applied for?

What is your academic interest?

Course number I will be registering for
example: ED 5030

School currently attending

Graduation year

Please note Plymouth allows non-matriculated students to take up to 12 credits before applying to a program.

Personal Information

Previous name

Student ID (previous students)

Date of Birth

Legal Sex

Last Four SSN Digits

Mailing Address

City

State

Zip

Cell Phone

May we send you occasional Text messages? *

By providing your number, you consent to receive notifications from Plymouth State University.
Reply STOP to unsubscribe. Message & Data rates may apply.

Alternate phone

Ethnicity/Race

Are you Hispanic/Latino?

Do you receive VA educational benefits?

Citizenship

United States Citizen

Non-Resident Alien

Resident Alien

Visa Status

Nation of Citizenship

Please complete prior to submitting

I certify that the information supplied on this form is true.

Student Financial Responsibility Agreement

By completing this form I understand and agree to the Student Financial Responsibility Agreement.