First Name

Middle Name

Last Name

Street address

City

State

Zip

Phone number

E-mail address

Month and Year of Birth (mm/yyyy)

Gender

Male Female

Program you plan to attend

Mon., Nov. 9, 2009, Student Center

Admissions category

New Undergrad Returning Undergrad - bachelor's not yet received Returning Undergrad - already completed bachelor's Transfer Grad Student Teacher Certification/Endorsement

Anticipated enrollment

Winter 2010 Spring 2010 Summer 2010 Fall 2010

Academic Program (if known)

Have you previously attended EMU?

Yes No

If yes, when did you last attend EMU?

Have you attended more than four colleges/universities?

Yes No

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