Questionnaire

First Name:                 Last Name:

Street Address:                     City:      

State: AL AK AS AZ AR CA CO CT DE DC FL GA GU HI ID IL IN IA KS KY LA ME MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND OH OK OR PA PR RI SC SD TN TX UT VT VA WA WV WI WY        Zip Code:

Home Phone:               E-mail Address:

High School:               Date of Graduation:

Class Rank:     Grade Point Average (GPA):    ACT/SAT Score:

High School Academic Honors:  Type academic honors here

Area of Education Interest:

Have you applied to NSU? Yes      No

Will you be applying to NSU?   Yes     No    Not Applicable

Additional Information: Type additional information here