III. SCHOLARSHIP PARTICIPATION INFORMATION
26. Are you a participant in Missouri's A+ program? (applicable to first-time freshmen) Yes No 27. Are you working toward an International Baccalaureate (IB) diploma at your high school? (applicable to first-time freshmen) Have your results sent electronically from IBO or send a copy of your diploma to:
28. Are you a participant in the Show-Me Scholars Initiative program? (applicable to first-time freshmen) (Must indicate in order to initiate a Show-Me Scholars Scholarship contract) 29. Have you participated in: Missouri Boys State Missouri Girls State
Yes
No
No (Information used for awarding Alumni Scholarship/Legacy Award)
Last
First
graduation year
Address if different from item #5: ____________________________________________________________________________________________
31. Have you participated in Missouri's MOST Program for a minimum of 2 years? 32. Are you a Phi Theta Kappa member? (applicable to transfer students) Yes
Yes
Name of alumni parent (at time of graduation): ________________________________________________________________________________
No
Must complete standard scholarship application and provide proof of attendance to: Office of Scholarships and Financial Assistance, 800 University Drive, 273 Administration Building, Maryville, MO 64468-6001
30. Are either of your parents/guardians a Northwest graduate?
Yes
Office of Scholarships and Financial Assistance, 800 University Drive, 273 Administration Building, Maryville, MO 64468-6001
Yes No
No
Provide a copy of membership certificate or documents verifying membership directly to: Office of Scholarships and Financial Assistance, 800 University Drive, 273 Administration Building, Maryville, MO 64468-6001
IV. ACADEMIC INFORMATION
33. Do you plan to enroll in ONLY online courses?
Yes
No
(Note: online only acceptance deadline: two weeks prior to first day of classes)
34. Have you ever applied to Northwest Missouri State University?
Yes
No
If yes, when? ________________________
Yes
No
If yes, when? ________________________
Yes
No
If yes, when? ________________________
Have you ever enrolled at Northwest Missouri State University?
35. Are you a high school graduate?
Yes
No Did you take the GED?
Expected date of high school graduation: _____________________________________________ (month/year)
High School Attended: ________________________________________________________ Phone number: _________________________
Address: ____________________________________________________________________________________________________________
Number and street
City
State
FOR OFFICE USE
ZIP code
Guidance counselor's email address: ____________________________________________________________________________________
36. Are you participating or have you ever participated in the AVID program?
Yes
No
An official copy of your high school transcript or your GED score report must be sent to Northwest for admission. 37. Have you taken the ACT/SAT?
Yes When? ____________ Have you requested your scores be sent to Northwest?
No
Yes
No
If no, when do you plan to take it? ____________________________________________________
The ACT (or SAT) is required for freshman admission. Transfer students are requested to submit ACT or SAT scores to assist with course placement. All education majors are required to have ACT or SAT scores on file with the Office of Admissions. 38. Have you ever earned college credit (including high school dual credit) or been enrolled at another college or university, not including Northwest Missouri State University? Yes No
Please provide the name and location of all colleges attended, dates of attendance, degrees earned or expected prior to enrollment at Northwest, beginning with the most recent. If currently enrolled, indicate in DATES space. Please include dual credit institutions. Failure to indicate colleges or universities in which you have been enrolled will void your admission to Northwest.
NAME OF COLLEGE
LOCATION (CITY & STATE)
DATES
DEGREES EARNED
FOR OFFICE USE
Official transcripts must be sent to Northwest from each institution attended. If you have taken or plan to take college-level examination program (CLEP) tests or advanced placement (AP) tests, you must have official score reports sent to Northwest in order to have scores evaluated. 39. Have you ever been suspended or dismissed from any other college or university? Yes No If yes, from where? ___________________________________________________________________ When? _________________ For what reason? ____________________________________________________________________________________________ Are you eligible to return to the last college or university you attended? Yes No V. GENERAL INFORMATION
All freshmen must live on campus unless living with parents/guardians, married or at least 21 years old. 40. Do you plan to apply for University residence hall housing? Yes No 41. Please mark those extracurricular activities in which you may wish to participate.
Varsity athletics Instrumental music Intramural sports Study abroad
Cheerleading Drama Student newspaper Dance
Choral music Radio/TV Equestrian team Marching band
Forensics/debate Lit. & arts magazine Yearbook Honors Program
Army ROTC Religious groups AP/CLEP credit Green campus
Fraternity/sorority Rodeo Student government Art
VI. SIGNATURE By signing this application, you are accepting Northwest Missouri State University’s computer policies as stated in the User’s Guide, available on the internet at www.nwmissouri.edu/compserv/clientcomputing/ComputingPolicies.htm. Acceptance of the Northwest Computer Policy is required before a computer username will be issued, to gain access to the computing services provided by Northwest. I certify that all information contained herein is true and complete in all respects, that no important information has been withheld, and that if the information changes in any material respect I will notify Northwest of that change. I further understand that any incomplete or false information provided on this application, or my failure to notify Northwest of a material change in that information, will void my admission. I will request that my official transcripts be sent immediately to Northwest. In addition, I agree to the release of any transcripts, student records and test scores to Northwest including any ACT, SAT score reports that Northwest may request from ACT or College Board. Also, I authorize the sharing of my Northwest academic record and appropriate major-field test scores with any educational institution previously attended for assessment of their academic instruction and to be in compliance with Missouri HB1042.
Signature Required ________________________________________________________________________ Date ______________________________ 6
NORTHWEST MISSOURI STATE UNIVERSITY
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