Individually Created Program (ICP)

Application Form

NMU IN:  ______________________    NMU Email Address: _______________________________

Transfer Student:    YES   or   NO     Date Entered NMU: ________________________________

Name:  ___________________________________________________________________________

                            Last                                   First                                             Middle

Signature:  ________________________________________       Date: ______________________

Local Address:  ____________________________________    _____________________________

                                          Street                                                                  City

 ____________________  ______________  (________)______________________

State                      Zip Code                                   Phone

ICP ADVISER INFORMATION:

           Title of Program:  ______________________________________________________

                        Adviser:   ______________________________________________________

Adviser Email Address:   ______________________________________________________

        Adviser Signature:  ______________________________________________________

Individually Created Program (ICP) Application Form....................124 cr.

Liberal Studies: 30-40 cr.