NEIU Early College Application

Fields with an asterisk (*) designated required field.

Enrollment Information

Select the semester and year of enrollment in courses.*

Student Name and Contact Information

Legal First Name*

Preferred First Name (if different than legal name)

Middle Name

Last Name*

Email Address*

Phone Number

Birthdate*

Sex*

Gender Identity

Address

Permanent Address*

Country

Street

City

Region

Postal Code

Parent Information

Parent first name*

Parent Last name*

Parent Email Address*

Parent Phone Number

High School Information

High School Name*

Year in high school*

Ethnicity

Are you Hispanic or Latin(x/a/o) (Person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race)?

Hispanic

Non-Hispanic

Please select your race: (select all that apply)

Early College Form Certification

This application must be signed electronically by the applicant before any action can be taken by the Admissions Office.

I understand that withholding information requested on this application, including attendance at any other institution or giving false information, may make me ineligible for admission to Northeastern Illinois University and that my admission may be rescinded and class registration canceled, if already admitted. I have read and understand all instructions and information on this application. I understand that, during the admissions process, Northeastern may communicate information intended only for me at the personal email account listed on this application. I certify that the statements I have made on this application are correct and complete.

Applicant Electronic Signature*

Date of Signature*