POST BAC APPLICATION

Page 1 of 2 - Post Bac Application

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APPLICATION FOR ADMISSION
Legal Name Legal Name First Last
Alternate name(s) that you have used previously (if applicable).
What semester and year do you plan to enroll in courses? (Ex: Summer 2024, Fall 2025, Spring 2026 etc.)
Minimum of 1 characters required. Currently Entered: 0 characters.
Sex

Sex Male Female
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
County
Email address
Phone Phone - ### - ### ####
Date of birth Date of birth / MM / DD YYYY
Last Four Digits of Social Security Number*
*Disclosure of the last four digits of your Social Security Number is required. It will be used for various administrative purposes at the university.
Have you attended or been admitted to Missouri State University previously (Dual Credit, prior application, etc.)?

Have you attended or been admitted to Missouri State University previously (Dual Credit, prior application, etc.)? Yes No
Please provide your BearPass ID (also known as M Number) if known.
Have you lived in Missouri the past 12 months for purposes other than being a student?

Have you lived in Missouri the past 12 months for purposes other than being a student? Yes No
In which state are you a resident?
Are you a U.S. citizen?

Are you a U.S. citizen? Yes No
If no, what is your nation of birth?
If no, what is your birth city?
If no, what is your nation of citizenship?
Are you a permanent resident?

Are you a permanent resident? Yes No
If you are not a U.S. citizen or permanent resident, indicate your Visa type (e.g., B-1, H-1) and the country issuing your passport:
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
Ethnicity: The following race and ethnicity questions are requested to assist the University in complying with Federal guidelines (these questions are optional).

Ethnicity: The following race and ethnicity questions are requested to assist the University in complying with Federal guidelines (these questions are optional). Hispanic or Latino Non-Hispanic or Latino

The following race and ethnicity questions are requested to assist the University in complying with Federal guidelines (these questions are optional).
Race: The following race and ethnicity questions are requested to assist the University in complying with Federal guidelines (these questions are optional).

Race: The following race and ethnicity questions are requested to assist the University in complying with Federal guidelines (these questions are optional). American Indian or Alaska native Asian Black or African American Native Hawaiian or other Pacific Islander White or Caucasian

The following race and ethnicity questions are requested to assist the University in complying with Federal guidelines (these questions are optional).
Have you ever been convicted of, or pled guilty to, a crime (other than a misdemeanor traffic offense); are any criminal charges pending against you; or have you been dismissed/suspended from another college or
university for disciplinary reasons?

Have you ever been convicted of, or pled guilty to, a crime (other than a misdemeanor traffic offense); are any criminal charges pending against you; or have you been dismissed/suspended from another college or
university for disciplinary reasons? Yes No
If yes to the 'Disciplinary action' question, have you attended Missouri State University since the infraction?

If yes to the 'Disciplinary action' question, have you attended Missouri State University since the infraction? Yes No
If you answered yes to the the 'Disciplinary action' question, please explain.
Maximum of 1000 characters allowed. Currently Entered: 0 characters.
Please check the item that best describes your most recent military status:

Please check the item that best describes your most recent military status: No affiliation Active duty Reservist National Guard Veteran Military dependent Prefer not to answer
Please check the item that best describes your most recent branch of service:

Please check the item that best describes your most recent branch of service: No affiliation Air Force Army Coast Guard Marine Corps Navy Prefer not to answer
Missouri State University (MSU) collects this information to enroll you into the university and to comply with federal and state law. Unless required by US law or authorized by university policy, MSU will not share your
personal information. Any sensitive information, including past disciplinary or criminal actions, is used only for internal review purposes.
TEACHER CERTIFICATION
Do you currently hold a teaching certificate in any area?

Do you currently hold a teaching certificate in any area? Yes No
If yes, what state and content area?
Please select the area of certification you wish to pursue

Please select the area of certification you wish to pursue Agriculture (Grades 9-12) Art (K-Grade 12) Chinese (K-Grade 12) English (Grades 9-12) Language Arts (Grades 5-9) Family and Consumer Science (K-Grade 12) French (K-Grade 12) German (K-Grade 12) Latin (K-Grade 12) Mathematics (Grades 9-12) Mathematics (Grades 5-9) Music - Instrumental (K-Grade 12) Music - Vocal Choral (K-Grade 12) Physical Education (K-Grade 12) Science (Grades 5-9) Social Studies (Grades 9-12) Social Studies (Grades 5-9) Spanish (K-Grade 12) Speech/Theater (Grades 9-12) Special Education Mild-Moderate Cross-Categorical (K-Grade 12) Blindness and Low Vision (Birth-Grade 12) Early Childhood Education (Birth-Grade 3) Elementary Education (Grades 1-6) Springfield Campus Elementary Education (Grades 1-6) West Plains Campus Elementary Education (Grades 1-6) Lebanon Campus Elementary Education (Grades 1-6) Crowder Campus School Counselor (K-Grade 12) School Psychological Examiner (K- Grade 12) Special Reading Certification (K-Grade 12) Teaching English to Speakers of Other Languages (K- Grade 12)
Highest diploma or degree earned

Highest diploma or degree earned Master's or higher (Post-Master) Bachelor's (Post-Baccalaureate) Associate's High School GED
School or college at which you earned the above diploma or degree(s):

Include name of school or college and state.
Save my progress and resume later
Enter Your Email Address *

A special link to resume the form will be sent to your email address.

POST BAC APPLICATION

POST BAC APPLICATION

Page 1 of 2 - Post Bac Application

APPLICATION FOR ADMISSION

TEACHER CERTIFICATION