First Name

Last Name

Street address

City

State

Zip

Phone number

E-mail address

Date of Birth (mm/dd/yyyy)

Gender

Male Female

High School or College currently attending

Admissions category

Freshman Transfer Graduate student Other

Anticipated enrollment

Winter 2009 Spring 2009 Summer 2009 Fall 2009 Winter 2010

Date you will attend:

October18

Number of Guests

Would you like to participate in Onsite Admissions?

Yes No

What other schools are you considering?

None Central Michigan University Ferris State University Grand Valley State University Michigan State University Oakland University University of Michigan, Ann Arbor Wayne State University Western Michigan University

How did you hear about Explore Eastern?

Billboard EMU Counselor visited your school High School Counselor Postcard EMU Website Radio Friend EMU Alumni College Fair High School Teacher Phone Call Other