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Northwest Missouri State University

Request for Undergraduate Information - SE

Student Information:
*First Name:
Middle Name:
*Last Name:
Date of Birth: (format: MM/DD/YYYY)
Contact Information:
*Address Line 1:
Address Line 2:
*City:
*State:
*ZIP Code:
Country:
(if other than the US)
Home Phone:
Cell Phone:
Would you like to receive text messages from Northwest?
Yes     No
E-mail Address:
Parent(s) E-mail:
School Information:
High School Name:
Graduation Year:
GPA:
ACT Score:
SAT Score:
If you are a transfer student, what college/university are you transferring from:
Additional Information:
Enrollment Status: Freshman
Returning
Transfer
Non-Degree Seeking
Graduate
When do you plan to enroll?
Major:
Are either of your parents/guardians Northwest alumni?
Yes     No
Ethnic Origin:
(check all that apply)
African American or Black
American Indian or Alaska Native
Asian
Hispanic Origin
Native Hawaiian or other Pacific Islander
White
I prefer not to respond
Other
Have you applied to Northwest?
Yes     No