Peoria Area Student Reception

Please complete this form with the student’s information, even if a parent or guardian is assisting. This helps us ensure we gather accurate registration information.

Contact Info:

Student First Name*

Student Preferred Name

Student Last Name*

Birthdate*

Mailing Address*

Country

Street

City

Region

Postal Code

Phone Number*

Mobile/Alternative Phone Number*

Missouri S&T’s communication plan includes text messages to the mobile number you provided above. If you wish to opt out of communications via text messages, please check here.

I do not wish to receive text messages

PLEASE NOTE: Confirmation materials are sent via email to both email addresses provided below.

Email Address *

Confirm Email Address*

Parent/Alternate Email Address

Academic Info:

Term You Anticipate Enrolling At Missouri S&T*

Intended Degree Program*

Intended Admission*

First-Time College Student

Transfer Student

School Currently Attending*

Guests:

Guest

First Name of Guest (1)

Last Name of Guest (1)

First Name of Guest (2)

Last Name of Guest (2)

Peoria Area Student Reception

Missouri S&T Admissions Missouri University of Science and Technology