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Northwest Missouri State University

Request for Information Undergraduate

Student Information:
*First Name:
Middle Name:
*Last Name:
Date of Birth:
(format: MM/DD/YYYY)
Contact Information:
*Address Line 1:
Address Line 2:
*ZIP Code:
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:
ACT Score:
SAT Score:
Additional Information:
Enrollment Status: Freshman
When do you plan to enroll?

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
Hispanic Origin
Native Hawaiian or other Pacific Islander
I prefer not to respond



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