Verification of Reciprocity Form
Southeast Technical is asking you to provide private information in order to process yourReciprocity Form This form is to be used by the receiving school to verify the residence of students attending from another state under current interstate reciprocity agreements.You are not legally required to provide this information; however, the college may not be able to effectively process your request if you do not provide sufficient information. Access to this information will be limited to school officials, including faculty who have legitimate educational interests in the information. Under certain circumstances, federal and state laws authorize release of private information without your consent: to other schools in which you seek or intend to enroll, or are enrolled; to federal, state or local officials for purposes of program compliance, audit or evaluation; as appropriate in connection with your application for, or receipt of, financial aid; if the information is sought with a court order or subpoena; or as otherwise permitted by other state or federal law.
What is your state of residence at time of application? (check one)
	Iowa		South Dakota
	Manitoba, Canada		Wisconsin
First Name:		MI:		Last Name:
Program Major:
Semester Start Date:	(mm/dd/yyyy)
Many colleges/universities use Social Security numbers for student identification purposes on student records. Providing your Social Security number is voluntary. If you do not provide this number, your request will still be processed, however it may be delayed. This data is requested for purposes of administration, program evaluation and consumer and alumni data. Your number also may be used to create summary information about MnSCU programs through data matches with other state agencies.
Social Security #:
Mailing Address:
City:		State:		Zip:
Permanent Address:
City:		State:		Zip:
I swear that all of the above statements are true to the best of my knowledge.
Date:	(mm/dd/yyyy)
Signature of Student: _____________________________________
(Signature of parent is needed if student is under 18 years of age)
Date:	(mm/dd/yyyy)
Signature of Parent: _____________________________________