NAME:
First: Middle: Maiden: Last:
Nickname/Name Used:

Student ID: (xxx-xx-xxxx)

LOCAL MAILING ADDRESS:
Address:
City: , Mississippi       Zip:

Hometown: (including state)

ACADEMIC INFORMATION:

Current Classification:
Anticipated Date of Graduation:

MC Academic (Honors/Awards/Accomplishments)

MC Non-Academic (Extracurricular activities / Clubs / Offices Held / Athletics / Awards / Other Campus Involvement)

Off-Campus (i.e. Church Work / Philanthropic efforts / Career Oriented efforts / Employment)

Please click SUBMIT only once!