First Name

Last Name

Street address

City

State

Zip

Phone number

E-mail address

Date of Birth

Gender

Male Female

Program you plan to attend

Wed.,Aug 13, EMU Student Center Wed.,Aug 20, MCCC Life Science Building Monroe

Admissions category

New Undergrad Returning Undergrad Transfer Grad Student Teacher Certification/Endorsement

Anticipated enrollment

Fall 2008 Winter 2009 Spring 2009 Summer 2009 Fall 2009 Winter 2010

Academic Program (if known)

Have you previously attended EMU?

Yes No

Last Semester of Attendance ?

How did you hear about Return to Learn?

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