Student Information

NMU IN:

E-mail:*

Street Address:*

Phone Number:*
- -

Demographic

Parent Information

Contact Phone:
- -

E-mail:

Educational Interests

Intended Major:*

Intended Minor: (if any)

Extracurricular Interests:
Types of activities you could see yourself involved in, e.g. sports, clubs, sororities, or fraternities.

Statement of Understanding

By entering my initials in the box below: I will abide by the requirements of participation in the PACE program. I understand that participation is voluntary, and that I can withdraw from the program at any time. I understand that by withdrawing from the program that I lose all privileges and benefits associated with the program. I understand that the information provided on this form will be used to for the sole purpose of entrance into the PACE program and assignment to a PACE Team.

Signature:*

Questions? E-mail the Web master, or call the MERC Office at 906-227-1554.