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







 

Parent Information


First Name:
    
Last Name:

Contact Phone:
- -

E-mail:

 

Educational Interests

Intended Major:*

Intended Minor: (if any)

Extracurricular Interests:

 

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.