Eagle Express Joint Admission/Records Release Form

Thank you for opting to participate in the Eagle Express Program! Please complete the form below and a member of the Transition Services team will be in touch to connect with your academic department and other valuable MSU resources. If you have any questions, please email transfer@moreheadstate.edu.

KCTCS ID:*
MSU ID:
First Name:*
Middle Name:
Last Name:*
Other name(s) under which records may be filed:
Permanent Address:*
City:*
State:*
ZIP code:*
How long have you lived at the above address?:	Please list in years and months
Previous address (if current address is less than 3 years):
Email:*
Cell phone:*	( ) - Second three digits Last four digits
Home phone:	( ) - Second three digits Last four digits
Sex:*	Male Female
If you are a returning student (previously attended MSU), please list the dates that you attended MSU:	If you attended other colleges or universities since last attending MSU, please use the “Returning Transfer Student” field below, list these institutions and submit transcripts.
If you are a Transfer Student or Returning Transfer Student, please list the previous colleges or universities below and submit your official transcripts.:	College/University - City, State - Dates Attended
Please check here if you are a current MSU student concurrently enrolled at KCTCS:
High School Graduation/Completion Date:*	Please include the date you graduated high school, the date you completed home school, or the date you completed your GED. Be sure to note if this is high school/home school/GED.
High School:*
City, State and ZIP for your high school:*
Anticipated KCTCS Start Term:*
Anticipated MSU Start Term:*
Anticipated MSU Academic Program:*	Use Academic Program description found in Undergraduate Catalog at www.moreheadstate.edu/catalog.
Anticipated KCTCS Academic Program:*	Use Academic Program description found in the undergraduate catalog or at www.kctcs.edu/students.
Ethnicity - Are you Hispanic or Latino?:*	No, not Hispanic or Latino Yes, Hispanic Latino
Race :*	American Indian or Alaskan Native Asian Black/African American Native Hawaiian or other Pacific Islander White/Non-Hispanic Select one or more
Marital Status:*	Single Married Divorced Widowed Separated
Citizenship - Are you a U.S. citizen?:*	Yes No
If no, resident alien?:	Yes No
If resident alien, what is your citizenship country?:
Emergency Contact Name:*
Emergency Contact Street Address:*
Emergency Contact City:*
Emergency Contact State:*
Emergency Contact ZIP code:*
Emergency Contact Email:*
Emergency Contact Phone Number:*	( ) - Second three digits Last four digits
Have you ever been convicted of a criminal offense other than a traffic violation?:*	Yes No If yes, download Background Release Form from our website and return with your application. (Minor traffic offenses, e.g., seat belt violations are exempt. Other charges resulting from traffic stops, e.g., drug possession and DUI must be reported.)
Do you intend to apply for financial aid?:*	Yes No
List any parent or grandparent who attended MSU:
Are you a first generation college student?:*	Yes No You are a first generation student if neither of your parents have earned a four-year degree.)
I am applying for the Joint Admission Program at the following KCTCS School:*	Ashland CTC Big Sandy CTC Bluegrass CTC Hazard CTC Maysville CTC Southeast KY CTC Select one.
Morehead State University may, from time to time, desire to use my photograph and/or personal data, including academic records, for publicity purposes for the University. I have read this statement and understand it, and hereby state that I do not object. (If you do object, you must notify Communications and Marketing, 200 Earle Clements Lane, Alumni Tower East, Morehead, KY 40351.) I agree to adhere to the rules and regulations of the University and certify that all statements in this application are true. I also understand that any misrepresentation of information will make me ineligible for admission to Morehead State University or subject to dismissal after admission has been granted.:	Type your name in place of a signature and type the date.
Authorization to Release Academic Records: I authorize Morehead State University and KCTCS to exchange my academic records for review as needed for dual admission/reverse transfer purposes. Federal Law requires the student’s signature for release of transcripts. All holds must be cleared before submitting a transcript request. By signing this form you are authorizing these schools to release information to each other about your student file. There is no expiration date for this request. If you would like to relinquish authorization, you must submit a request in writing to the Registrar’s Office at both institutions.:	Type your name in place of a signature and type the date.
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