iStudy Adult Learner Application

Instructions
Applicant
Current Address
Permanent Address
School
Course
Submit

Form Instructions

Please click 'Begin' below to begin filling in the information for your application. Once you have entered all required information, click on the Submit tab.

To be eligible for the "Adult Learner" discount, you must be over 25 and not seeking a UM degree. You may only use this discount for one course.

Please contact us at 662-915-7313 or istudy@olemiss.edu if you have questions.

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Applicant Information

First Name:		*
Middle Name:
Last Name:		*
Preferred Email Address (UM if applicable):	You must have an '@' symbol in a valid email address. There must be at least one period following the @ sign in this e-mail address.	*
Alternate Email Address:		* *
Date of Birth:		*
Gender:	Please be advised that providing information about your race/ethnicity is voluntary. This information will be used in a non-discriminatory manner, consistent with applicable civil rights laws.	*
Ethnicity:		*

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Current Address Information

Country:
Address:		*
City:		*
State/Province/Region:		*
Postal/Zip Code:	Zipcode must be #### or #####-#### format.	*
Primary Telephone Number:	Telephone numbers must be in ###-###-#### format.	*

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Permanent Address Information

My permanent address is the same as my current address.


Country:
Address:		*
City:		*
State/Province/Region:		*
Postal/Zip Code:	Zipcode must be #### or #####-#### format.	*
Alternate Phone Number:	Telephone numbers must be in ###-###-#### format.

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School Information

Choose your status:	UM Student Non-UM Student	*
Student ID Number:	ID number should contain 8 digits only (no preceding zeros).	*
How did you find out about iStudy?	Name of staff member: * Position: * If you selected "other" please elaborate here:*	*
Eligibility for the Adult Learner Tuition discount:	I am over 25 years of age. I am not currently working toward a degree at the University of Mississippi. I have not used this tuition discount to pay for another University of Mississippi iStudy course. To be eligible you must be over 25 and not seeking a UM degree. You may only use this discount for one course.
Check if you are:		*

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Course Information

Course Type:		*
Course:		*

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Submit Application

Total Amount Due: $ 0.00

I plan to pay by:

Bursar Account (for UM Students only)
By Check or Credit Card

Add the following two numbers together and type the result in the box.
(used to deter automated spam submissions)

6 + 3 =

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