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Northwest Missouri State University


Application for Enrollment (New Student)

* indicates required fields
Please note: If you do not receive a confirmation email regarding your child's application within one month, please contact the office.

Child Information
* First Name
* Last Name
* Gender Female     Male
* Birthday (format: MM/DD/YYYY)

* Does this child have siblings?
Yes     No

* If yes, does the child's sibling attend Horace Mann or Leet Center?
Yes     No

1. Parent/Guardian 2. Parent/Guardian
* Name: Name:
* Street Address: Street Address:
* City, State, Zip: City, State, Zip:
* Home Phone: Home Phone:
* Cell Phone: Cell Phone:
* Email Address:
(for confirmation)
Email Address:
(for confirmation)

I understand that this application does not constitute actual enrollment in the Early Childhood Center. I realize that actual enrollment in the school is governed by limitations of class size and by priorities established by the Board of Regents of the University. I understand that my child’s name will be placed on a waiting list.
Yes     No

I attest that my child is not currently suspended or expelled from any public district or private school in the United States.
Yes     No

* Legal Signature of Parent/Guardian: