Colorado School of Mines Returning Student Application

Name:	, Last First Middle
Address:
City:
State:
Zip Code:
Phone:
E-Mail Address:
CWID:
Date of Birth:
Sex:	Male Female
Country of Citizenship:
Ethnic (optional):

Term and Year Re-entering CSM:	Fall Spring Summer Field
Seeking another CSM undergraduate degree:	Yes No             Degree:
CSM graduation date:	(month/year)
Dates of previous attendance:
Class when last attended:	Freshman Sophomore Junior Senior
Degree option:
Have you ever been on suspension from CSM:	Yes No             From: to:
Are/were you required to see the Readmissions Committee before registering again at CSM:	Yes No             Date: Time:

Are you claiming tuition classification as a Colorado resident?       Yes No

If yes, completion of all the questions in this section is required.

	You	Your Parent/Guardian (if you are under 22)
Dates of continuous physical presence in Colorado (mo/yr):
Date Colorado Driver's License was first issued (mo/yr):
Date Current Colorado Driver's License was issued (mo/yr):
List last 3 years of Colorado Motor Vehicle registration:
Date of Colorado Voter Registration (mo/yr):
Date of purchase or lease of any Colorado residential property (mo/yr):
Dates of employment in Colorado (mo/yr):
Dates of military service, if applicable (mo/yr):
List last 3 years Colorado income taxes have been filed:
Date of marriage (mo/yr) - Answer this question only if you will be under 21 by initial enrollment date:
If your parents are separated or divorced, which one lives in Colorado:
Dates of extended absences from Colorado (Gone for more than one month at a time):

Students who claim a change in tuition classification must contact the Registrars Office for further information. Dependents of non-resident active duty military personnel stationed in Colorado may request a tuition adjustment to in-state-rates. For information, contact your Military Base Education Office.