eservices.minnstate.edu
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URL:
https://eservices.minnstate.edu/student-portal/prospect/createAccount?campusid=304&return=https://xsexy.it
Submission: On October 07 via api from BE — Scanned from DE
Submission: On October 07 via api from BE — Scanned from DE
Form analysis 1 forms found in the DOM
POST saveProspect
<form class="form-horizontal" action="saveProspect" id="saveProspect" role="form" method="POST" autocomplete="on">
<section data-wizard="section" class="chunk">
<h2 class="h4">Personal Information</h2>
<p class="help-block">Fields marked with an asterisk are required to submit the form.</p>
<hr>
<div class="form-group required">
<label for="first_name" class="col-md-4 col-lg-2 control-label">* First name </label>
<div class="col-md-8 col-lg-10">
<input type="text" name="first_name" class="form-control" id="first_name" value="" title="First name is required. Please enter." required="true" autofocus="autofocus">
</div>
</div>
<div class="form-group">
<label for="middle_name" class="col-md-4 col-lg-2 control-label">Middle name</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="middle_name" class="form-control" id="middle_name" value="">
</div>
</div>
<div class="form-group required">
<label for="last_name" class="col-md-4 col-lg-2 control-label">* Last name</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="last_name" class="form-control" id="last_name" value="" title="Last name is required. Please enter." required="true">
</div>
</div>
<div class="form-group">
<label for="suffix" class="col-md-4 col-lg-2 control-label">Suffix</label>
<div class="col-sm-5 col-md-4">
<input type="text" name="suffix" class="form-control" id="suffix" value="" placeholder="Jr., Sr., etc.">
</div>
</div>
<div class="form-group">
<label for="birthday" class="col-md-4 col-lg-2 control-label">Birthday</label>
<div class="col-md-8 col-lg-10">
<div class="input-group">
<span class="input-group-btn">
<button type="button" class="btn btn-default" data-container="body" data-toggle="popover" data-placement="right" data-content="We ask your date of birth and Social Security Number to help ensure we don't create duplicate accounts."
data-original-title="" title="">
<span class="glyphicon glyphicon-info-sign"> </span>
<span class="sr-only">Info</span>
</button>
</span>
<input type="date" name="birthday" class="form-control" id="birthday" value="" title="Birthday must be a valid date. Please re-enter.">
</div>
</div>
</div>
<div class="form-group">
<label for="ssn" class="col-md-4 col-lg-2 control-label">Social Security Number</label>
<div class="col-md-8 col-lg-10">
<div class="input-group">
<span class="input-group-btn">
<button type="button" class="btn btn-default" data-container="body" data-toggle="popover" data-placement="right"
data-content="If you intend to apply for financial aid, providing your Social Security number on your account may help to ensure that your financial aid application can be matched up with this account and assist in processing."
data-original-title="" title="">
<span class="glyphicon glyphicon-info-sign"> </span>
<span class="sr-only">Info</span>
</button>
</span>
<input type="text" name="ssn" class="form-control" id="ssn" value="" pattern="^[0-9]{9}$" data-replace="[^\d]" title="Incorrect SSN entered. Please re-enter." placeholder="Example: 123460101">
</div>
</div>
</div>
<hr>
<div class="form-group required">
<label for="email" class="col-md-4 col-lg-2 control-label">* Email</label>
<div class="col-md-8 col-lg-10">
<input type="email" name="email" class="form-control" id="email" value="" title="Email address format is invalid. Please re-enter." required="true" placeholder="example@website.com">
</div>
</div>
<div class="form-group required">
<label for="email2" class="col-md-4 col-lg-2 control-label">* Re-enter email</label>
<div class="col-md-8 col-lg-10">
<input type="email" class="form-control" id="email2" title="Confirmation email address format is invalid. Please re-enter." data-comparison="email" data-comparison-title="Confirmation email doesn't match email address"
placeholder="example@website.com" required="">
</div>
</div>
<hr>
<div class="form-group required">
<label for="password1" class="col-md-4 col-lg-2 control-label">* Password</label>
<div class="col-md-8 col-lg-10">
<input type="password" name="password1" class="form-control" id="password1" title="Password entered doesn't meet the rules." required="" value="">
</div>
</div>
<div class="form-group required">
<label for="password2" class="col-md-4 col-lg-2 control-label">* Re-enter</label>
<div class="col-md-8 col-lg-10">
<input type="password" class="form-control" id="password2" title="A password confirmation is required." data-comparison="password1" data-comparison-title="Confirmation password doesn't match password" required="">
</div>
</div>
<p class="help-block col-md-offset-2 col-md-10">Passwords must be at least 8 characters long and must contain at least three of these types of characters: uppercase, lowercase, numbers or special characters. Passwords may not include your name.
</p>
</section>
<section data-wizard="section" class="chunk hide" aria-hidden="true">
<h2 class="h4">Contact</h2>
<hr>
<div class="form-group required">
<label for="country" class="col-md-4 col-lg-2 control-label">* Country</label>
<div class="col-md-8 col-lg-10">
<select class="form-control" name="country" id="country">
<option value="AB">Abu Dhabi</option>
<option value="AF">Afghanistan</option>
<option value="AL">Albania</option>
<option value="DZ">Algeria</option>
<option value="AS">American Samoa</option>
<option value="AD">Andorra</option>
<option value="AO">Angola</option>
<option value="AI">Anguilla</option>
<option value="AQ">Antarctica</option>
<option value="AG">Antigua and Barbuda</option>
<option value="AR">Argentina</option>
<option value="AM">Armenia</option>
<option value="AW">Aruba</option>
<option value="AC">Ashmore and Cartier Islands</option>
<option value="AU">Australia</option>
<option value="AT">Austria</option>
<option value="AZ">Azerbaijan</option>
<option value="PO">Azores</option>
<option value="BS">Bahamas</option>
<option value="BH">Bahrain</option>
<option value="FQ">Baker Island</option>
<option value="SP">Balearic Islands (Mallorca)</option>
<option value="BD">Bangladesh</option>
<option value="BB">Barbados</option>
<option value="IB">Bassas da India</option>
<option value="BL">Belarus</option>
<option value="BE">Belgium</option>
<option value="BZ">Belize</option>
<option value="BJ">Benin</option>
<option value="BM">Bermuda</option>
<option value="BT">Bhutan</option>
<option value="BO">Bolivia</option>
<option value="BA">Bosnia and Herzegovina</option>
<option value="BW">Botswana</option>
<option value="BV">Bouvet Island</option>
<option value="BR">Brazil</option>
<option value="IO">British Indian Ocean Territory</option>
<option value="VG">British Virgin Islands</option>
<option value="BN">Brunei</option>
<option value="BG">Bulgaria</option>
<option value="BF">Burkina Faso (Upper Volta)</option>
<option value="BU">Burma</option>
<option value="BI">Burundi</option>
<option value="KH">Cambodia</option>
<option value="CM">Cameroon</option>
<option value="CA">Canada</option>
<option value="CD">Canary Islands</option>
<option value="CV">Cape Verde</option>
<option value="KY">Cayman Islands</option>
<option value="CF">Central African Republic</option>
<option value="TD">Chad</option>
<option value="CL">Chile</option>
<option value="CN">China</option>
<option value="CX">Christmas Island</option>
<option value="IP">Clipperton Island</option>
<option value="CC">Cocos (Keeling) Islands</option>
<option value="CO">Colombia</option>
<option value="KM">Comoros</option>
<option value="CK">Cook Islands</option>
<option value="CT">Coral Seas Islands Territory</option>
<option value="VP">Corsica</option>
<option value="CR">Costa Rica</option>
<option value="HR">Croatia (Hrvatska)</option>
<option value="CU">Cuba</option>
<option value="UC">Curacao</option>
<option value="CY">Cyprus</option>
<option value="CZ">Czech Republic</option>
<option value="CS">Czechoslovakia</option>
<option value="KP">Democratic People's Republic of Korea</option>
<option value="CG">Democratic Republic of the Congo</option>
<option value="DK">Denmark</option>
<option value="DJ">Djibouti</option>
<option value="DM">Dominica</option>
<option value="DO">Dominican Republic</option>
<option value="DU">Dubai</option>
<option value="TP">East Timor</option>
<option value="EC">Ecuador</option>
<option value="EG">Egypt</option>
<option value="SV">El Salvador</option>
<option value="EI">Eleuthera Island</option>
<option value="GQ">Equatorial Guinea</option>
<option value="ER">Eritrea</option>
<option value="EE">Estonia</option>
<option value="SZ">Eswatini</option>
<option value="ET">Ethiopia</option>
<option value="EU">Europa Island</option>
<option value="FK">Falkland Islands (Malvinas)</option>
<option value="FO">Faroe Islands</option>
<option value="FJ">Fiji</option>
<option value="FI">Finland</option>
<option value="FR">France</option>
<option value="GF">French Guiana</option>
<option value="PF">French Polynesia</option>
<option value="TF">French Southern and Antarctic Lands</option>
<option value="GA">Gabon</option>
<option value="GM">Gambia</option>
<option value="GZ">Gaza Strip</option>
<option value="GE">Georgia</option>
<option value="DD">German Democratic Republic</option>
<option value="DE">Germany</option>
<option value="GH">Ghana</option>
<option value="GI">Gibraltar</option>
<option value="GO">Glorioso Islands</option>
<option value="GR">Greece</option>
<option value="GL">Greenland</option>
<option value="GD">Grenada</option>
<option value="GP">Guadeloupe</option>
<option value="GU">Guam</option>
<option value="GT">Guatemala</option>
<option value="GK">Guernsey</option>
<option value="GN">Guinea</option>
<option value="GW">Guinea-Bissau</option>
<option value="GY">Guyana</option>
<option value="HT">Haiti</option>
<option value="HM">Heard and McDonald Islands</option>
<option value="HN">Honduras</option>
<option value="HK">Hong Kong</option>
<option value="HQ">Howland Island</option>
<option value="HU">Hungary</option>
<option value="IS">Iceland</option>
<option value="IN">India</option>
<option value="ID">Indonesia</option>
<option value="IR">Iran</option>
<option value="IQ">Iraq</option>
<option value="IE">Ireland</option>
<option value="IM">Isle of Man</option>
<option value="IL">Israel</option>
<option value="IT">Italy</option>
<option value="CI">Ivory Coast (Cote D'Ivoire)</option>
<option value="JM">Jamaica</option>
<option value="JN">Jan Mayen</option>
<option value="JP">Japan</option>
<option value="DQ">Jarvis Island</option>
<option value="JE">Jersey</option>
<option value="JQ">Johnston Atoll</option>
<option value="JO">Jordan</option>
<option value="JU">Juan de Nova Island</option>
<option value="KZ">Kazakhstan</option>
<option value="KE">Kenya</option>
<option value="KQ">Kingman Reef</option>
<option value="KI">Kiribati</option>
<option value="YO">Kosovo</option>
<option value="RS">Kurile Islands</option>
<option value="KW">Kuwait</option>
<option value="KG">Kyrgyzstan</option>
<option value="LA">Lao People's Democratic Republic</option>
<option value="LV">Latvia</option>
<option value="LB">Lebanon</option>
<option value="LS">Lesotho</option>
<option value="LR">Liberia</option>
<option value="LY">Libyan Arab Jamahiriya</option>
<option value="LI">Liechtenstein</option>
<option value="LT">Lithuania</option>
<option value="LU">Luxembourg</option>
<option value="MO">Macau</option>
<option value="MG">Madagascar</option>
<option value="MW">Malawi</option>
<option value="MY">Malaysia</option>
<option value="MV">Maldives</option>
<option value="ML">Mali</option>
<option value="MT">Malta</option>
<option value="MH">Marshall Islands</option>
<option value="MQ">Martinique</option>
<option value="MR">Mauritania</option>
<option value="MU">Mauritius</option>
<option value="YT">Mayotte</option>
<option value="MX">Mexico</option>
<option value="FM">Micronesia</option>
<option value="MI">Midway Islands</option>
<option value="MD">Moldova</option>
<option value="MC">Monaco</option>
<option value="MN">Mongolia</option>
<option value="ME">Montenegro</option>
<option value="MS">Montserrat</option>
<option value="MA">Morocco</option>
<option value="MZ">Mozambique</option>
<option value="NA">Namibia</option>
<option value="NR">Nauru</option>
<option value="BQ">Navassa Island</option>
<option value="NP">Nepal</option>
<option value="NL">Netherlands</option>
<option value="AN">Netherlands Antilles</option>
<option value="NT">Neutral Zone</option>
<option value="NC">New Caledonia</option>
<option value="NZ">New Zealand</option>
<option value="NI">Nicaragua</option>
<option value="NE">Niger</option>
<option value="NG">Nigeria</option>
<option value="NU">Niue</option>
<option value="NF">Norfolk Island</option>
<option value="MK">North Macedonia</option>
<option value="ND">Northern Ireland</option>
<option value="MP">Northern Mariana Islands</option>
<option value="NO">Norway</option>
<option value="OM">Oman</option>
<option value="PK">Pakistan</option>
<option value="PW">Palau</option>
<option value="LQ">Palmyra Atoll</option>
<option value="PA">Panama</option>
<option value="PG">Papua New Guinea</option>
<option value="PI">Paracel Islands</option>
<option value="PY">Paraguay</option>
<option value="PE">Peru</option>
<option value="PH">Philippines</option>
<option value="PN">Pitcairn Islands</option>
<option value="PL">Poland</option>
<option value="PT">Portugal</option>
<option value="PR">Puerto Rico</option>
<option value="QA">Qatar</option>
<option value="RD">Redonda</option>
<option value="KR">Republic of Korea</option>
<option value="CJ">Republic of the Congo</option>
<option value="RE">Reunion</option>
<option value="RO">Romania</option>
<option value="RU">Russian Federation</option>
<option value="RW">Rwanda</option>
<option value="JA">Ryukyu Islands</option>
<option value="GS">S. Georgia and S. Sandwich Isls.</option>
<option value="SM">San Marino</option>
<option value="ST">Sao Tome and Principe</option>
<option value="SW">Sarawak</option>
<option value="SA">Saudi Arabia</option>
<option value="SN">Senegal</option>
<option value="SS">Serbia</option>
<option value="SX">Serbia Prior to 2001</option>
<option value="SC">Seychelles</option>
<option value="SL">Sierra Leone</option>
<option value="SG">Singapore</option>
<option value="SK">Slovakia</option>
<option value="SI">Slovenia</option>
<option value="SB">Solomon Islands</option>
<option value="SO">Somalia</option>
<option value="ZA">South Africa</option>
<option value="ES">Spain</option>
<option value="PS">Spratly Islands</option>
<option value="LK">Sri Lanka</option>
<option value="VC">St Vincent and the Grenadines</option>
<option value="SH">St. Helena</option>
<option value="KN">St. Kitts (St. Christopher & Nevis)</option>
<option value="LC">St. Lucia</option>
<option value="PM">St. Pierre and Miquelon</option>
<option value="ZY">Stateless Country</option>
<option value="SD">Sudan</option>
<option value="SR">Suriname</option>
<option value="SJ">Svalbard</option>
<option value="SE">Sweden</option>
<option value="CH">Switzerland</option>
<option value="SY">Syria</option>
<option value="TW">Taiwan</option>
<option value="TJ">Tajikistan</option>
<option value="TZ">Tanzania, United Republic of</option>
<option value="TH">Thailand</option>
<option value="TG">Togo</option>
<option value="TK">Tokelau</option>
<option value="TO">Tonga</option>
<option value="TL">Tortola</option>
<option value="TT">Trinidad and Tobago</option>
<option value="TE">Tromelin Island</option>
<option value="TN">Tunisia</option>
<option value="TR">Turkey</option>
<option value="TM">Turkmenistan</option>
<option value="TC">Turks and Caicos Islands</option>
<option value="TV">Tuvalu</option>
<option value="UG">Uganda</option>
<option value="UA">Ukraine</option>
<option value="SU">Union of Soviet Socialist Republics</option>
<option value="AE">United Arab Emirates</option>
<option value="GB">United Kingdom (Great Britain)</option>
<option value="VI">United States Virgin Islands</option>
<option value="US" selected="selected">United States of America</option>
<option value="UK">UnitedKngdm-Englnd,Wale,Scotlnd,N.Irelnd</option>
<option value="ZZ">Unknown or Unspecified Country</option>
<option value="UY">Uruguay</option>
<option value="UZ">Uzbekistan</option>
<option value="VU">Vanuatu</option>
<option value="VA">Vatican City</option>
<option value="VE">Venezuela</option>
<option value="VN">Vietnam</option>
<option value="WQ">Wake Island</option>
<option value="WF">Wallis and Futuna</option>
<option value="WE">West Bank</option>
<option value="EH">Western Sahara</option>
<option value="WS">Western Samoa</option>
<option value="WI">Windward Islands</option>
<option value="YE">Yemen</option>
<option value="YU">Yugoslavia</option>
<option value="ZM">Zambia</option>
<option value="ZW">Zimbabwe</option>
</select>
</div>
</div>
<div class="form-group required">
<label for="address1" class="col-md-4 col-lg-2 control-label">* Address 1</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="address1" class="form-control" id="address1" value="" title="Address line 1 is required. Please enter." placeholder="Street address" required="true">
</div>
</div>
<div class="form-group">
<label for="address2" class="col-md-4 col-lg-2 control-label">Address 2</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="address2" class="form-control" id="address2" value="">
</div>
</div>
<div class="form-group hidden-input" style="display: none;">
<label for="address3" class="col-md-4 col-lg-2 control-label">Address 3</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="address3" class="form-control" id="address3" value="">
</div>
</div>
<div class="form-group hidden-input" style="display: none;">
<label for="address4" class="col-md-4 col-lg-2 control-label">Address 4</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="address4" class="form-control" id="address4" value="">
</div>
</div>
<div class="form-group hidden-input" style="display: none;">
<label for="address5" class="col-md-4 col-lg-2 control-label">Address 5</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="address5" class="form-control" id="address5" value="">
</div>
</div>
<div class="form-group required">
<label for="city" class="col-md-4 col-lg-2 control-label">* City</label>
<div class="col-md-8 col-lg-10">
<input type="text" name="city" class="form-control" id="city" value="" title="City is required. Please-enter." required="true">
</div>
</div>
<div class="form-group required">
<label for="state-province" class="col-md-4 col-lg-2 control-label">* State or Province</label>
<div class="col-md-8 col-lg-10">
<select name="state-province" id="state-province" class="form-control" required="">
<optgroup label="United States">
<option value="AK">Alaska</option>
<option value="AL">Alabama</option>
<option value="AR">Arkansas</option>
<option value="AZ">Arizona</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DC">District of Columbia</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="IA">Iowa</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="MA">Massachusetts</option>
<option value="MD">Maryland</option>
<option value="ME">Maine</option>
<option value="MI">Michigan</option>
<option value="MN" selected="selected">Minnesota</option>
<option value="MO">Missouri</option>
<option value="MS">Mississippi</option>
<option value="MT">Montana</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="NE">Nebraska</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NV">Nevada</option>
<option value="NY">New York</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VA">Virginia</option>
<option value="VI">Virgin Islands</option>
<option value="VT">Vermont</option>
<option value="WA">Washington</option>
<option value="WI">Wisconsin</option>
<option value="WV">West Virginia</option>
<option value="WY">Wyoming</option>
<option value="AS">American Samoa</option>
<option value="MP">North Mariana Islands</option>
<option value="FM">Fed States Micronesia</option>
<option value="MH">Marshall Islands</option>
<option value="PW">Palau</option>
</optgroup>
<optgroup label="Canada">
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NS">Nova Scotia</option>
<option value="NT">Northwest Territories</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="SK">Saskatchewan</option>
<option value="NU">Nunavut</option>
<option value="NL">Newfoundland&Labrador</option>
<option value="QC">Quebec</option>
<option value="YT">Yukon Territory</option>
</optgroup>
<option value="NA">Not in US or Canada</option>
</select>
</div>
</div>
<div class="form-group">
<label for="zip" class="col-xs-12 col-md-4 col-lg-2 control-label">* Zip</label>
<div class="col-xs-8 col-md-6 col-lg-8">
<input type="number" name="zip" class="form-control" id="zip" value="" placeholder="Zip" required="required" title="Zip code is required. Please enter.">
</div>
<label for="zip-suffix" class="sr-only">Zip Suffix</label>
<div class="col-xs-4 col-md-2 col-lg-2">
<input type="text" name="zip-suffix" class="form-control" id="zip-suffix" value="" placeholder="+4">
</div>
</div>
<div class="form-group">
<label for="county" class="col-xs-12 col-md-4 col-lg-2 control-label">County</label>
<div class="col-xs-12 col-md-8 col-lg-10">
<select name="county" id="county" class="form-control">
<option value=""></option>
<option value="000">Other</option>
<optgroup label="Minnesota Counties">
<option value="001">Aitkin</option>
<option value="002">Anoka</option>
<option value="003">Becker</option>
<option value="004">Beltrami</option>
<option value="005">Benton</option>
<option value="006">Big Stone</option>
<option value="007">Blue Earth</option>
<option value="008">Brown</option>
<option value="009">Carlton</option>
<option value="010">Carver</option>
<option value="011">Cass</option>
<option value="012">Chippewa</option>
<option value="013">Chisago</option>
<option value="014">Clay</option>
<option value="015">Clearwater</option>
<option value="016">Cook</option>
<option value="017">Cottonwood</option>
<option value="018">Crow Wing</option>
<option value="019">Dakota</option>
<option value="020">Dodge</option>
<option value="021">Douglas</option>
<option value="022">Faribault</option>
<option value="023">Fillmore</option>
<option value="024">Freeborn</option>
<option value="025">Goodhue</option>
<option value="026">Grant</option>
<option value="027">Hennepin</option>
<option value="028">Houston</option>
<option value="029">Hubbard</option>
<option value="030">Isanti</option>
<option value="031">Itasca</option>
<option value="032">Jackson</option>
<option value="033">Kanabec</option>
<option value="034">Kandiyohi</option>
<option value="035">Kittson</option>
<option value="036">Koochiching</option>
<option value="037">Lac Qui Parle</option>
<option value="038">Lake</option>
<option value="039">Lake Of Woods</option>
<option value="040">Le Sueur</option>
<option value="041">Lincoln</option>
<option value="042">Lyon</option>
<option value="044">Mahnomen</option>
<option value="045">Marshall</option>
<option value="046">Martin</option>
<option value="043">Mcleod</option>
<option value="047">Meeker</option>
<option value="048">Mille Lacs</option>
<option value="049">Morrison</option>
<option value="050">Mower</option>
<option value="051">Murray</option>
<option value="052">Nicollet</option>
<option value="053">Nobles</option>
<option value="054">Norman</option>
<option value="055">Olmsted</option>
<option value="056">Otter Tail</option>
<option value="057">Pennington</option>
<option value="058">Pine</option>
<option value="059">Pipestone</option>
<option value="060">Polk</option>
<option value="061">Pope</option>
<option value="062">Ramsey</option>
<option value="063">Red Lake</option>
<option value="064">Redwood</option>
<option value="065">Renville</option>
<option value="066">Rice</option>
<option value="067">Rock</option>
<option value="068">Roseau</option>
<option value="070">Scott</option>
<option value="071">Sherburne</option>
<option value="072">Sibley</option>
<option value="069">St Louis</option>
<option value="073">Stearns</option>
<option value="074">Steele</option>
<option value="075">Stevens</option>
<option value="076">Swift</option>
<option value="077">Todd</option>
<option value="078">Traverse</option>
<option value="000">Unknown</option>
<option value="079">Wabasha</option>
<option value="080">Wadena</option>
<option value="081">Waseca</option>
<option value="082">Washington</option>
<option value="083">Watonwan</option>
<option value="084">Wilkin</option>
<option value="085">Winona</option>
<option value="086">Wright</option>
<option value="087">Yellow Medicine</option>
</optgroup>
<optgroup label="Iowa Counties">
<option value="001">Adair</option>
<option value="002">Adams</option>
<option value="003">Allamakee</option>
<option value="004">Appanoose</option>
<option value="005">Audubon</option>
<option value="006">Benton</option>
<option value="007">Black Hawk</option>
<option value="008">Boone</option>
<option value="009">Bremer</option>
<option value="010">Buchanan</option>
<option value="011">Buena Vista</option>
<option value="012">Butler</option>
<option value="013">Calhoun</option>
<option value="014">Carroll</option>
<option value="015">Cass</option>
<option value="016">Cedar</option>
<option value="017">Cerro Gordo</option>
<option value="018">Cherokee</option>
<option value="019">Chickasaw</option>
<option value="020">Clarke</option>
<option value="021">Clay</option>
<option value="022">Clayton</option>
<option value="023">Clinton</option>
<option value="024">Crawford</option>
<option value="025">Dallas</option>
<option value="026">Davis</option>
<option value="027">Decatur</option>
<option value="028">Delaware</option>
<option value="029">Des Moines</option>
<option value="030">Dickinson</option>
<option value="031">Dubuque</option>
<option value="032">Emmet</option>
<option value="033">Fayette</option>
<option value="034">Floyd</option>
<option value="035">Franklin</option>
<option value="036">Fremont</option>
<option value="037">Greene</option>
<option value="038">Grundy</option>
<option value="039">Guthrie</option>
<option value="040">Hamilton</option>
<option value="041">Hancock</option>
<option value="042">Hardin</option>
<option value="043">Harrison</option>
<option value="044">Henry</option>
<option value="045">Howard</option>
<option value="046">Humboldt</option>
<option value="047">Ida</option>
<option value="048">Iowa</option>
<option value="049">Jackson</option>
<option value="050">Jasper</option>
<option value="051">Jefferson</option>
<option value="052">Johnson</option>
<option value="053">Jones</option>
<option value="054">Keokuk</option>
<option value="055">Kossuth</option>
<option value="056">Lee</option>
<option value="057">Linn</option>
<option value="058">Louisa</option>
<option value="059">Lucas</option>
<option value="060">Lyon</option>
<option value="061">Madison</option>
<option value="062">Mahaska</option>
<option value="063">Marion</option>
<option value="064">Marshall</option>
<option value="065">Mills</option>
<option value="066">Mitchell</option>
<option value="067">Monona</option>
<option value="068">Monroe</option>
<option value="069">Montgomery</option>
<option value="070">Muscatine</option>
<option value="071">OBrien</option>
<option value="072">Osceola</option>
<option value="073">Page</option>
<option value="074">Palo Alto</option>
<option value="075">Plymouth</option>
<option value="076">Pocahontas</option>
<option value="077">Polk</option>
<option value="078">Pottawattamie</option>
<option value="079">Poweshiek</option>
<option value="080">Ringgold</option>
<option value="081">Sac</option>
<option value="082">Scott</option>
<option value="083">Shelby</option>
<option value="084">Sioux</option>
<option value="085">Story</option>
<option value="086">Tama</option>
<option value="087">Taylor</option>
<option value="088">Union</option>
<option value="000">Unknown</option>
<option value="089">Van Buren</option>
<option value="090">Wapello</option>
<option value="091">Warren</option>
<option value="092">Washington</option>
<option value="093">Wayne</option>
<option value="094">Webster</option>
<option value="095">Winnebago</option>
<option value="096">Winneshiek</option>
<option value="097">Woodbury</option>
<option value="098">Worth</option>
<option value="099">Wright</option>
</optgroup>
<optgroup label="North Dakota Counties">
<option value="001">Adams</option>
<option value="002">Barnes</option>
<option value="003">Benson</option>
<option value="004">Billings</option>
<option value="005">Bottineau</option>
<option value="006">Bowman</option>
<option value="007">Burke</option>
<option value="008">Burleigh</option>
<option value="009">Cass</option>
<option value="010">Cavalier</option>
<option value="011">Dickey</option>
<option value="012">Divide</option>
<option value="013">Dunn</option>
<option value="014">Eddy</option>
<option value="015">Emmons</option>
<option value="016">Foster</option>
<option value="017">Golden Valley</option>
<option value="018">Grand Forks</option>
<option value="019">Grant</option>
<option value="020">Griggs</option>
<option value="021">Hettinger</option>
<option value="022">Kidder</option>
<option value="023">La Moure</option>
<option value="024">Logan</option>
<option value="025">Mc Henry</option>
<option value="028">Mc Lean</option>
<option value="026">Mcintosh</option>
<option value="027">Mckenzie</option>
<option value="029">Mercer</option>
<option value="030">Morton</option>
<option value="031">Mountrail</option>
<option value="032">Nelson</option>
<option value="033">Oliver</option>
<option value="034">Pembina</option>
<option value="035">Pierce</option>
<option value="036">Ramsey</option>
<option value="037">Ransom</option>
<option value="038">Renville</option>
<option value="039">Richland</option>
<option value="040">Rolette</option>
<option value="041">Sargent</option>
<option value="042">Sheridan</option>
<option value="043">Sioux</option>
<option value="044">Slope</option>
<option value="045">Stark</option>
<option value="046">Steele</option>
<option value="047">Stutsman</option>
<option value="048">Towner</option>
<option value="049">Traill</option>
<option value="000">Unknown</option>
<option value="050">Walsh</option>
<option value="051">Ward</option>
<option value="052">Wells</option>
<option value="053">Williams</option>
</optgroup>
<optgroup label="South Dakota Counties">
<option value="001">Aurora</option>
<option value="002">Beadle</option>
<option value="003">Bennett</option>
<option value="004">Bon Homme</option>
<option value="005">Brookings</option>
<option value="006">Brown</option>
<option value="007">Brule</option>
<option value="008">Buffalo</option>
<option value="009">Butte</option>
<option value="010">Campbell</option>
<option value="011">Charles Mix</option>
<option value="012">Clark</option>
<option value="013">Clay</option>
<option value="014">Codington</option>
<option value="015">Corson</option>
<option value="016">Custer</option>
<option value="017">Davison</option>
<option value="018">Day</option>
<option value="019">Deuel</option>
<option value="020">Dewey</option>
<option value="021">Douglas</option>
<option value="022">Edmunds</option>
<option value="023">Fall River</option>
<option value="024">Faulk</option>
<option value="025">Grant</option>
<option value="026">Gregory</option>
<option value="027">Haakon</option>
<option value="028">Hamlin</option>
<option value="029">Hand</option>
<option value="030">Hanson</option>
<option value="031">Harding</option>
<option value="032">Hughes</option>
<option value="033">Hutchinson</option>
<option value="034">Hyde</option>
<option value="035">Jackson</option>
<option value="036">Jerauld</option>
<option value="037">Jones</option>
<option value="038">Kingsbury</option>
<option value="039">Lake</option>
<option value="040">Lawrence</option>
<option value="041">Lincoln</option>
<option value="042">Lyman</option>
<option value="043">Marshall</option>
<option value="044">Mccook</option>
<option value="045">Mcpherson</option>
<option value="046">Meade</option>
<option value="047">Mellette</option>
<option value="048">Miner</option>
<option value="049">Minnehaha</option>
<option value="050">Moody</option>
<option value="051">Pennington</option>
<option value="052">Perkins</option>
<option value="053">Potter</option>
<option value="054">Roberts</option>
<option value="055">Sanborn</option>
<option value="056">Shannon</option>
<option value="057">Spink</option>
<option value="058">Stanley</option>
<option value="059">Sully</option>
<option value="060">Todd</option>
<option value="061">Tripp</option>
<option value="062">Turner</option>
<option value="063">Union</option>
<option value="000">Unknown</option>
<option value="064">Walworth</option>
<option value="065">Yankton</option>
<option value="066">Ziebach</option>
</optgroup>
<optgroup label="Wisconsin Counties">
<option value="001">Adams</option>
<option value="002">Ashland</option>
<option value="003">Barron</option>
<option value="004">Bayfield</option>
<option value="005">Brown</option>
<option value="006">Buffalo</option>
<option value="007">Burnett</option>
<option value="008">Calumet</option>
<option value="009">Chippewa</option>
<option value="010">Clark</option>
<option value="011">Columbia</option>
<option value="012">Crawford</option>
<option value="013">Dane</option>
<option value="014">Dodge</option>
<option value="015">Door</option>
<option value="016">Douglas</option>
<option value="017">Dunn</option>
<option value="018">Eau Claire</option>
<option value="019">Florence</option>
<option value="020">Fond du Lac</option>
<option value="021">Forest</option>
<option value="022">Grant</option>
<option value="023">Green</option>
<option value="024">Green Lake</option>
<option value="025">Iowa</option>
<option value="026">Iron</option>
<option value="027">Jackson</option>
<option value="028">Jefferson</option>
<option value="029">Juneau</option>
<option value="030">Kenosha</option>
<option value="031">Kewaunee</option>
<option value="032">La Crosse</option>
<option value="033">Lafayette</option>
<option value="034">Langlade</option>
<option value="035">Lincoln</option>
<option value="036">Manitowoc</option>
<option value="037">Marathon</option>
<option value="038">Marinette</option>
<option value="039">Marquette</option>
<option value="040">Menominee</option>
<option value="041">Milwaukee</option>
<option value="042">Monroe</option>
<option value="043">Oconto</option>
<option value="044">Oneida</option>
<option value="045">Outagamie</option>
<option value="046">Ozaukee</option>
<option value="047">Pepin</option>
<option value="048">Pierce</option>
<option value="049">Polk</option>
<option value="050">Portage</option>
<option value="051">Price</option>
<option value="052">Racine</option>
<option value="053">Richland</option>
<option value="054">Rock</option>
<option value="055">Rusk</option>
<option value="057">Sauk</option>
<option value="058">Sawyer</option>
<option value="059">Shawano</option>
<option value="060">Sheboygan</option>
<option value="056">St Croix</option>
<option value="061">Taylor</option>
<option value="062">Trempealeau</option>
<option value="000">Unknown</option>
<option value="063">Vernon</option>
<option value="064">Vilas</option>
<option value="065">Walworth</option>
<option value="066">Washburn</option>
<option value="067">Washington</option>
<option value="068">Waukesha</option>
<option value="069">Waupaca</option>
<option value="070">Waushara</option>
<option value="071">Winnebago</option>
<option value="072">Wood</option>
</optgroup>
</select>
</div>
</div>
<hr>
<div class="form-group form-phone">
<label for="phone" class="col-xs-12 col-md-4 col-lg-2 control-label">* Phone</label>
<label for="phone-country" class="sr-only">Country code</label>
<div class="col-xs-3 col-md-2" style="display: none;">
<input type="text" name="phone-country" class="form-control" id="phone-country" value="" placeholder="+1">
</div>
<div class="required col-xs-12 col-md-8 col-lg-10">
<input type="tel" name="phone" class="form-control" id="phone" pattern="^[0-9]{10,10}" data-replace="[^\d]" value="" title="A valid phone number is required." required="true" placeholder="Example: 6125551212">
</div>
</div>
<div class="form-group form-phone">
<label for="mobile" class="col-xs-12 col-md-4 col-lg-2 control-label">Mobile </label>
<label for="mobile-country" class="sr-only">Country code</label>
<div class="col-xs-3 col-md-2" style="display: none;">
<input type="text" name="mobile-country" class="form-control" id="mobile-country" value="" placeholder="+1">
</div>
<div class="col-xs-12 col-md-8 col-lg-10">
<input type="tel" name="mobile" class="form-control" id="mobile" value="" pattern="^[0-9]{10,10}" data-replace="[^\d]" title="Mobile phone number requires 10 digits. Please re-enter." placeholder="Mobile phone, if different than above">
</div>
</div>
</section>
<section data-wizard="section" class="chunk hide" aria-hidden="true">
<h2 class="h4">Citizenship</h2>
<hr>
<p>This information is required to determine residency for tuition.</p>
<fieldset>
<legend class="col-sm-4 control-label">* Are you a US Citizen?</legend>
<div class="col-sm-8">
<label for="radio1" class="radio-inline">
<input type="radio" name="citizen" id="radio1" value="Y" required="" title="Please select your Citizenship Status"> Yes </label>
<label for="radio2" class="radio-inline">
<input type="radio" name="citizen" id="radio2" value="N"> No </label>
</div>
</fieldset>
<div id="residency-status" class="residency-input" style="display: none;">
<div class="form-group">
<label for="residency_status" class="control-label col-sm-4">* What is your residency status?</label>
<div class="form-group">
<div class="col-sm-4">
<select class="form-control" id="residency_status" name="residency_status">
<option value="02">Non-Resident Alien</option>
<option value="03">Resident Alien</option>
<option value="04">Dual National</option>
<option value="81">United States Citizen -- Non Resident</option>
<option value="83">Refugee/Asylee</option>
<option value="85">Temporary Protected Status</option>
<option value="98">Unknown</option>
<option value="99">Other</option>
</select>
</div>
</div>
</div>
</div>
<hr>
<div class="" id="prosperity-act" style="display: none;">
<h3 class="h4">Prosperity Act</h3>
<p>Minnesota's Prosperity Act provides the opportunity for undocumented immigrants to qualify for in-state tuition, state financial aid and private scholarships. Qualifications include 3 years attendance at a Minnesota high school, a Minnesota
high school diploma or awarding of a GED from a Minnesota site, and compliance with the selective service registration requirements. The information collected in the Prosperity Act section below is only used for determination of your
residency status.</p>
<p>If you are an undocumented immigrant in Minnesota, please complete the high school and Selective Service questions as part of this application. Your high school transcript must be sent to the college or university to which you are applying
as validation of your high school attendance.</p>
<div class="col-sm-12">
<fieldset>
<legend class="col-sm-4 control-label">Have you attended high school in Minnesota for 3 or more years?</legend>
<label for="radio3" class="radio-inline">
<input type="radio" name="prosperity" id="radio3" value="Y"> Yes </label>
<label for="radio4" class="radio-inline">
<input type="radio" name="prosperity" id="radio4" value="N"> No </label>
</fieldset>
</div>
<p>As part of the Prosperity Act, male students who are 18 to 25 years of age must have registered with the Selective Service to be considered for in-state tuition. Females are not required to register. To learn more about the registration
requirements you can visit the Selective Service System website.</p>
<div class="col-sm-12">
<fieldset>
<legend class="col-sm-4 control-label">Please indicate the following: </legend>
<label for="radio5" class="radio col-sm-8">
<input type="radio" name="selective-service" id="radio5" value="Y"> I have registered for Selective Service and will provide a copy of my registration card </label>
<label for="radio4" class="radio col-sm-8 col-sm-offset-4">
<input type="radio" name="selective-service" id="radio6" value="N"> I have not registered with Selective Service </label>
<label for="radio7" class="radio col-sm-8 col-sm-offset-4">
<input type="radio" name="selective-service" id="radio7" value="NR"> I am not required to register for Selective Service </label>
</fieldset>
</div>
</div>
</section>
<section data-wizard="section" class="chunk hide" aria-hidden="true">
<h2 class="h4">Residency</h2>
<hr>
<div class="form-group required">
<label for="residence" class="col-lg-3 control-label">* What is your state of residence?</label>
<div class="col-lg-6">
<select name="residence" id="residence" class="form-control" value="">
<optgroup label="United States">
<option value="AK">Alaska</option>
<option value="AL">Alabama</option>
<option value="AR">Arkansas</option>
<option value="AZ">Arizona</option>
<option value="CA">California</option>
<option value="CO">Colorado</option>
<option value="CT">Connecticut</option>
<option value="DC">District of Columbia</option>
<option value="DE">Delaware</option>
<option value="FL">Florida</option>
<option value="GA">Georgia</option>
<option value="GU">Guam</option>
<option value="HI">Hawaii</option>
<option value="IA">Iowa</option>
<option value="ID">Idaho</option>
<option value="IL">Illinois</option>
<option value="IN">Indiana</option>
<option value="KS">Kansas</option>
<option value="KY">Kentucky</option>
<option value="LA">Louisiana</option>
<option value="MA">Massachusetts</option>
<option value="MD">Maryland</option>
<option value="ME">Maine</option>
<option value="MI">Michigan</option>
<option value="MN">Minnesota</option>
<option value="MO">Missouri</option>
<option value="MS">Mississippi</option>
<option value="MT">Montana</option>
<option value="NC">North Carolina</option>
<option value="ND">North Dakota</option>
<option value="NE">Nebraska</option>
<option value="NH">New Hampshire</option>
<option value="NJ">New Jersey</option>
<option value="NM">New Mexico</option>
<option value="NV">Nevada</option>
<option value="NY">New York</option>
<option value="OH">Ohio</option>
<option value="OK">Oklahoma</option>
<option value="OR">Oregon</option>
<option value="PA">Pennsylvania</option>
<option value="PR">Puerto Rico</option>
<option value="RI">Rhode Island</option>
<option value="SC">South Carolina</option>
<option value="SD">South Dakota</option>
<option value="TN">Tennessee</option>
<option value="TX">Texas</option>
<option value="UT">Utah</option>
<option value="VA">Virginia</option>
<option value="VI">Virgin Islands</option>
<option value="VT">Vermont</option>
<option value="WA">Washington</option>
<option value="WI">Wisconsin</option>
<option value="WV">West Virginia</option>
<option value="WY">Wyoming</option>
<option value="AS">American Samoa</option>
<option value="MP">North Mariana Islands</option>
<option value="FM">Fed States Micronesia</option>
<option value="MH">Marshall Islands</option>
<option value="PW">Palau</option>
</optgroup>
<optgroup label="Canada">
<option value="AB">Alberta</option>
<option value="BC">British Columbia</option>
<option value="MB">Manitoba</option>
<option value="NB">New Brunswick</option>
<option value="NS">Nova Scotia</option>
<option value="NT">Northwest Territories</option>
<option value="ON">Ontario</option>
<option value="PE">Prince Edward Island</option>
<option value="SK">Saskatchewan</option>
<option value="NU">Nunavut</option>
<option value="NL">Newfoundland&Labrador</option>
<option value="QC">Quebec</option>
<option value="YT">Yukon Territory</option>
</optgroup>
<option value="NA">Not in US or Canada</option>
</select>
</div>
</div>
<div class="form-group required">
<div class="col-md-12">
<p class="help-block">How long have you lived in the state listed above?</p>
</div>
<label for="years-residence" class="col-lg-2 control-label">* Years</label>
<div class="col-lg-2">
<input type="number" name="years-residence" class="form-control" id="years-residence" required="true" title="Years of residency can be between 0 and 99. Please re-enter." min="0" max="99" value="">
</div>
<label for="months-residence" class="col-lg-2">* Months</label>
<div class="col-lg-2">
<input type="number" min="0" max="11" name="months-residence" class="form-control" id="months-residence" required="true" title="Months of residency can be between 0 and 11. Please re-enter." value="">
</div>
</div>
<button id="submitButton" type="submit" class="btn btn-success" data-spinner="overlay" data-spinner-title="This may take a minute or two...">Submit</button>
</section>
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Toggle navigation Student e-services Skip navigation * Student e-services * Find a course * Campus links * Century College Home * Bookstore * Records and Registration * Tuition and Fees * Continuing Education Registration CREATE A MINNESOTA STATE STARID ACCOUNT Create a Minnesota State StarID account * What is a StarID account? * I already have a Minnesota State StarID. -------------------------------------------------------------------------------- * Personal Information * Contact * Citizenship * Residency PERSONAL INFORMATION Fields marked with an asterisk are required to submit the form. -------------------------------------------------------------------------------- * First name Middle name * Last name Suffix Birthday Info Social Security Number Info -------------------------------------------------------------------------------- * Email * Re-enter email -------------------------------------------------------------------------------- * Password * Re-enter Passwords must be at least 8 characters long and must contain at least three of these types of characters: uppercase, lowercase, numbers or special characters. Passwords may not include your name. CONTACT -------------------------------------------------------------------------------- * Country Abu Dhabi Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ashmore and Cartier Islands Australia Austria Azerbaijan Azores Bahamas Bahrain Baker Island Balearic Islands (Mallorca) Bangladesh Barbados Bassas da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso (Upper Volta) Burma Burundi Cambodia Cameroon Canada Canary Islands Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Coral Seas Islands Territory Corsica Costa Rica Croatia (Hrvatska) Cuba Curacao Cyprus Czech Republic Czechoslovakia Democratic People's Republic of Korea Democratic Republic of the Congo Denmark Djibouti Dominica Dominican Republic Dubai East Timor Ecuador Egypt El Salvador Eleuthera Island Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Europa Island Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gambia Gaza Strip Georgia German Democratic Republic Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard and McDonald Islands Honduras Hong Kong Howland Island Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Ivory Coast (Cote D'Ivoire) Jamaica Jan Mayen Japan Jarvis Island Jersey Johnston Atoll Jordan Juan de Nova Island Kazakhstan Kenya Kingman Reef Kiribati Kosovo Kurile Islands Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Midway Islands Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Namibia Nauru Navassa Island Nepal Netherlands Netherlands Antilles Neutral Zone New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Macedonia Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Palmyra Atoll Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Redonda Republic of Korea Republic of the Congo Reunion Romania Russian Federation Rwanda Ryukyu Islands S. Georgia and S. Sandwich Isls. San Marino Sao Tome and Principe Sarawak Saudi Arabia Senegal Serbia Serbia Prior to 2001 Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Spratly Islands Sri Lanka St Vincent and the Grenadines St. Helena St. Kitts (St. Christopher & Nevis) St. Lucia St. Pierre and Miquelon Stateless Country Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania, United Republic of Thailand Togo Tokelau Tonga Tortola Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine Union of Soviet Socialist Republics United Arab Emirates United Kingdom (Great Britain) United States Virgin Islands United States of America UnitedKngdm-Englnd,Wale,Scotlnd,N.Irelnd Unknown or Unspecified Country Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wake Island Wallis and Futuna West Bank Western Sahara Western Samoa Windward Islands Yemen Yugoslavia Zambia Zimbabwe * Address 1 Address 2 Address 3 Address 4 Address 5 * City * State or Province Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming American Samoa North Mariana Islands Fed States Micronesia Marshall Islands Palau Alberta British Columbia Manitoba New Brunswick Nova Scotia Northwest Territories Ontario Prince Edward Island Saskatchewan Nunavut Newfoundland&Labrador Quebec Yukon Territory Not in US or Canada * Zip Zip Suffix County Other Aitkin Anoka Becker Beltrami Benton Big Stone Blue Earth Brown Carlton Carver Cass Chippewa Chisago Clay Clearwater Cook Cottonwood Crow Wing Dakota Dodge Douglas Faribault Fillmore Freeborn Goodhue Grant Hennepin Houston Hubbard Isanti Itasca Jackson Kanabec Kandiyohi Kittson Koochiching Lac Qui Parle Lake Lake Of Woods Le Sueur Lincoln Lyon Mahnomen Marshall Martin Mcleod Meeker Mille Lacs Morrison Mower Murray Nicollet Nobles Norman Olmsted Otter Tail Pennington Pine Pipestone Polk Pope Ramsey Red Lake Redwood Renville Rice Rock Roseau Scott Sherburne Sibley St Louis Stearns Steele Stevens Swift Todd Traverse Unknown Wabasha Wadena Waseca Washington Watonwan Wilkin Winona Wright Yellow Medicine Adair Adams Allamakee Appanoose Audubon Benton Black Hawk Boone Bremer Buchanan Buena Vista Butler Calhoun Carroll Cass Cedar Cerro Gordo Cherokee Chickasaw Clarke Clay Clayton Clinton Crawford Dallas Davis Decatur Delaware Des Moines Dickinson Dubuque Emmet Fayette Floyd Franklin Fremont Greene Grundy Guthrie Hamilton Hancock Hardin Harrison Henry Howard Humboldt Ida Iowa Jackson Jasper Jefferson Johnson Jones Keokuk Kossuth Lee Linn Louisa Lucas Lyon Madison Mahaska Marion Marshall Mills Mitchell Monona Monroe Montgomery Muscatine OBrien Osceola Page Palo Alto Plymouth Pocahontas Polk Pottawattamie Poweshiek Ringgold Sac Scott Shelby Sioux Story Tama Taylor Union Unknown Van Buren Wapello Warren Washington Wayne Webster Winnebago Winneshiek Woodbury Worth Wright Adams Barnes Benson Billings Bottineau Bowman Burke Burleigh Cass Cavalier Dickey Divide Dunn Eddy Emmons Foster Golden Valley Grand Forks Grant Griggs Hettinger Kidder La Moure Logan Mc Henry Mc Lean Mcintosh Mckenzie Mercer Morton Mountrail Nelson Oliver Pembina Pierce Ramsey Ransom Renville Richland Rolette Sargent Sheridan Sioux Slope Stark Steele Stutsman Towner Traill Unknown Walsh Ward Wells Williams Aurora Beadle Bennett Bon Homme Brookings Brown Brule Buffalo Butte Campbell Charles Mix Clark Clay Codington Corson Custer Davison Day Deuel Dewey Douglas Edmunds Fall River Faulk Grant Gregory Haakon Hamlin Hand Hanson Harding Hughes Hutchinson Hyde Jackson Jerauld Jones Kingsbury Lake Lawrence Lincoln Lyman Marshall Mccook Mcpherson Meade Mellette Miner Minnehaha Moody Pennington Perkins Potter Roberts Sanborn Shannon Spink Stanley Sully Todd Tripp Turner Union Unknown Walworth Yankton Ziebach Adams Ashland Barron Bayfield Brown Buffalo Burnett Calumet Chippewa Clark Columbia Crawford Dane Dodge Door Douglas Dunn Eau Claire Florence Fond du Lac Forest Grant Green Green Lake Iowa Iron Jackson Jefferson Juneau Kenosha Kewaunee La Crosse Lafayette Langlade Lincoln Manitowoc Marathon Marinette Marquette Menominee Milwaukee Monroe Oconto Oneida Outagamie Ozaukee Pepin Pierce Polk Portage Price Racine Richland Rock Rusk Sauk Sawyer Shawano Sheboygan St Croix Taylor Trempealeau Unknown Vernon Vilas Walworth Washburn Washington Waukesha Waupaca Waushara Winnebago Wood -------------------------------------------------------------------------------- * Phone Country code Mobile Country code CITIZENSHIP -------------------------------------------------------------------------------- This information is required to determine residency for tuition. * Are you a US Citizen? Yes No * What is your residency status? Non-Resident Alien Resident Alien Dual National United States Citizen -- Non Resident Refugee/Asylee Temporary Protected Status Unknown Other -------------------------------------------------------------------------------- PROSPERITY ACT Minnesota's Prosperity Act provides the opportunity for undocumented immigrants to qualify for in-state tuition, state financial aid and private scholarships. Qualifications include 3 years attendance at a Minnesota high school, a Minnesota high school diploma or awarding of a GED from a Minnesota site, and compliance with the selective service registration requirements. The information collected in the Prosperity Act section below is only used for determination of your residency status. If you are an undocumented immigrant in Minnesota, please complete the high school and Selective Service questions as part of this application. Your high school transcript must be sent to the college or university to which you are applying as validation of your high school attendance. Have you attended high school in Minnesota for 3 or more years? Yes No As part of the Prosperity Act, male students who are 18 to 25 years of age must have registered with the Selective Service to be considered for in-state tuition. Females are not required to register. To learn more about the registration requirements you can visit the Selective Service System website. Please indicate the following: I have registered for Selective Service and will provide a copy of my registration card I have not registered with Selective Service I am not required to register for Selective Service RESIDENCY -------------------------------------------------------------------------------- * What is your state of residence? Alaska Alabama Arkansas Arizona California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Virgin Islands Vermont Washington Wisconsin West Virginia Wyoming American Samoa North Mariana Islands Fed States Micronesia Marshall Islands Palau Alberta British Columbia Manitoba New Brunswick Nova Scotia Northwest Territories Ontario Prince Edward Island Saskatchewan Nunavut Newfoundland&Labrador Quebec Yukon Territory Not in US or Canada How long have you lived in the state listed above? * Years * Months Submit ← PreviousNext → × ALREADY HAVE A STUDENT ID? If you have a Student ID (Tech ID) from a Minnesota State institution, you will still need to create an account if you wish to apply to a different institution. You can also create an account so you can register for public courses at a Minnesota State institution. You can do that here. * Create an account from my Student ID (Tech ID) at Bemidji State University * Create an account from my Student ID (Tech ID) at another Minnesota State institution. You will be asked to log in first. Close × WHAT IS A STARID ACCOUNT? A StarID account lets you register for open public courses at any college and university within the Minnesota State system. Going forward, your StarID will be used to register for classes, check your grades, pay bills and many more features throughout your lifecycle as a Minnesota State student. Close Century College 3300 Century Avenue N. White Bear Lake, MN 55110 Phone: 651-779-3200 | Fax: 651-773-1796 Minnesota State Colleges and Universities is an equal opportunity employer and educator. Logo Century College is a member of the Minnesota State Colleges and Universities system.