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Request for Information: Undergraduate - PE

Student Information

*First Name:

Middle Name:

*Last Name:

Date of Birth:

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

Email Address:

Parent(s) Email:

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) White
African American or Black
American Indian or Alaska Native
Asian
Hispanic Origin
Native Hawaiian or other Pacific Islander
I prefer not to respond
Other

Have you applied to Northwest? Yes
No