North Park University - Christian, Urban, Multicultural

Location:

Title:

First Name:

Last Name:

Middle Initial:

Mailing Address:

City:

State:

Zip Code:

Country:

Day Phone No.:

Evening Phone No.:

Other Phone No.:

Email address:

Gender:

Male
Female

Colleges previously attended and degrees earned:

Planned entry semester:

Fall
Spring
Summer

Planned entry year:

Religious Affiliation (optional):

Ethnic background (optional):

American Indian/Alaskan Native
African/African American
Asian/Pacific Islander
Hispanic
White/non-Hispanic

Are you an international student?

Yes
No

How did you hear about North Park?

Friend
Direct Mail
Current Student
College/Career Fair
Web site

Publication:

Other:

Additional comments:

School of Adult Learning: Request Further Information