NSU Early Start to Undergraduate Admissions Application

 


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1. Name:

 

First:
Middle:
Last:

 

2.  Social Security Number (ex. 123-12-1234):

 

  -    - 

3.  Date Of Birth (mm/dd/yyyy):

 

 /  /

4. Home Address:

 

Street and Number :
City:
State:
Zip Code:

5.  Phone Number:

 

6.  Cell Phone Number:

 

7.  E-Mail Address:

 

8.  High School:

 

9.  Expected Graduation Date:

 

10.  Previous College/University Attended (other than NSU) thru Dual Enrollment:

 

11.  Intended Major While At NSU:

 

12.  Comments Regarding Application:

 


Please confirm that the above information is correct and click the submit button below.