Senior Citizen Student Status Request Form

Contact Information

Your first step is to complete an application for admission to Metro State. Once you are admitted, complete this form to request Senior Citizen student status. To qualify, you must be a Minnesota resident and 62 years of age or older by the first day of the term you wish to attend.

First Name

Middle Name

Last Name

Birthdate

Minnesota State Star ID

Phone Number

Email Address

Mailing Address

Country

Street

City

Region

Postal Code

Education Plans

Are you planning to take undergraduate or graduate courses?

Undergraduate

Graduate

Are you planning to earn a certificate or degree at Metro State?

Yes

No

Select your program

Metro State University is asking you to provide information that includes private and/or confidential information under state and federal law. We are asking for this information in order to process your application form. You are not legally required to provide the information the university is requesting; however, the university may not be able to effectively process your application if you do not provide sufficient information.

Please attach a photocopy of your MN driver's license or State ID.

I acknowledge that I have completed this form. Please type in your name and date.