Jump Start Application Form | NMU Multicultural Education and Resource Center

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Jump Start Program Application

For more information, visit the Jump Start online.

* - Required field

Student Information

First Name:*

Last Name:*

NMU IN:

E-mail:*

Street Address:*

City:

State:

Zip:

Phone Number:*
- -

Demographic

African American / Black
Caucasian / White
Hispanic / Latino(a)
Multiracial
Asian or Pacific Islander
Native American
Prefer not to respond

Parent Information

First Name:

Last Name:

Contact Phone:
- -

E-mail:

Educational Interests

Intended Major:*

Intended Minor: (if any)

Extracurricular Interests:
Types of activities you could see yourself involved in, e.g. sports, clubs, sororities, or fraternities.

Statement of Understanding

By entering my initials in the box below: I will abide by the requirements of participation in the Jump Start program. I understand that participation is voluntary, and that I can withdraw from the program at any time. I understand that by withdrawing from the program that I lose all privileges and benefits associated with the program. I understand that the information provided on this form will be used to for the sole purpose of entrance into the Jump Start program and assignment to a Jump Start Team.

Signature:*

Questions? E-mail the Web master, or call the MERC Office at 906-227-1554.