First Name

Last Name

Street address

City

State

Zip

Phone number

E-mail address

Parent's E-mail address

Date of Birth (mm/dd/yyyy)

Gender

Male Female

High School or College currently attending (or last attended)

Grade level

9101112HS GraduateTransferCollege Graduateother

Anticipated major

Would you like to participate in Priority Admissions?

Yes No

What other schools are you considering?

Bowling Green University Central Michigan University Ferris State University Grand Valley State University Michigan State University Oakland University University of Michigan, Ann Arbor University of Toledo Wayne State University Western Michigan University Other

How did you hear about this visit program?

Letter from EMU Admissions EMU Counselor visited your school High School Counselor Daily Campus Tour Brochure EMU Website Newspaper/advertisement Friend EMU Alumni College Fair High School Teacher Phone Call Other

Number of Guests (excluding the student - limit 4)

01234