You must have JavaScript enabled to use this form. Prospective Student's Information Please complete as much as you know or can learn from the prospective student. Student's Name Home Address Street Address City State - None -AlabamaAlaskaAmerican SamoaArizonaArkansasArmed Forces (Canada, Europe, Africa, or Middle East)Armed Forces AmericasArmed Forces PacificCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFederated States of MicronesiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarshall IslandsMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPalauPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirgin IslandsVirginiaWashingtonWest VirginiaWisconsinWyoming Zip Phone E-mail address Program level of academic interest Undergraduate Graduate Graduation Year School or college most recently attended Academic or career interest, if known Your Information Referral type Personal Referral Student Contacted Department/Faculty Your name NMU department (if relevant) Phone E-mail address Please select your association NMU: NMU Alumni NMU Faculty NMU Staff NMU Student Other… Enter other… Leave this field blank
