Murray State University

Basic Information

First Name*

Middle Name

Last Name*

Preferred Name

Email Address*

Confirm Email Address*

Home Phone

Cell Phone

May we contact you by text message?

YesNo

Parent Information

Parent/Guardian 1 Prefix

Parent/Guardian 1 First Name

Parent/Guardian 1 Middle Name

Parent/Guardian 1 Last Name

Parent/Guardian 1 Suffix

Parent/Guardian 1 International Address?

YesNo

Parent/Guardian 1 Email Address

Parent/Guardian 1 Address Line 1

Parent/Guardian 1 Address Line 2

Parent/Guardian 1 City

Parent/Guardian 1 Address 3

Parent/Guardian 1 State/Province

Parent/Guardian 1 Zip/Postal Code

Parent/Guardian 1 Home Phone

Parent/Guardian 1 Country

Parent/Guardian 2 Prefix

Parent/Guardian 2 Last Name

Parent/Guardian 2 Middle Name

Parent/Guardian 2 First Name

Parent/Guardian 2 Suffix

Parent/Guardian 2 International Address?

YesNo

Parent/Guardian 2 Email Address

Parent/Guardian 2 Address Line 1

Parent/Guardian 2 Address Line 2

Parent/Guardian 2 City

Parent/Guardian 2 Address Line 3

Parent/Guardian 2 State/Province

Parent/Guardian 2 Zip/Postal Code

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Country

Account Information

Password (Note: Must be 6 characters or longer with 1 or more non-alphanumeric characters)*

Confirm Password*

Password Question*If you forget your password, we will ask you this question in order to reset it.

If you forget your password, we will ask you this question in order to reset it.

Password Answer*If you forget your password, you must provide this answer in order to reset it.

If you forget your password, you must provide this answer in order to reset it.

Murray State University

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