APPLICATION FOR THE UNIVERSITY HONORS PROGRAM

NORTHERN ILLINOIS UNIVERSITY

(Continuing NIU Student)

NAME ________________________________________________________________ Z-ID_______________________________

(Print or Type) Last

First

Initial

PERMANENT ADDRESS _____________________________________________________________________________________

Street

City

State

Zip

_____________________________________
HOME TELEPHONE

________________________________________________________________
Name(s) of Parent(s), Guardian(s), or Spouse (Circle Category)

BIRTH DATE_____________

SEX: M_____ F______

E-MAIL ADDRESS
_________________________________

NIU CAMPUS OR LOCAL ADDRESS __________________________________________________________________________

(If applicable)

Street or
Residence
Hall and
Room
City

State
Zip

CAMPUS/LOCAL PHONE ______________________________

YEAR OF HIGH SCHOOL GRADUATION______________

HIGH SCHOOL _____________________________________________________________________________________________

Name

City

State

COLLEGE(S) OR UNIVERSITY(IES) ATTENDED:

TOTAL HOURS: _______________________________

1. _______________________________________________________

CUMULATIVE GPA: ___________________________

2. _______________________________________________________

JOINING NIU HONORS FOR: ____________________

3. _______________________________________________________

Semester,

Year

PROBABLE NIU MAJOR(S): _________________________________

MINOR(S): ________________________________

To monitor compliance with civil rights legislation, federal and state agencies require universities to describe their racial/ethnic
populations. Your response to the following will assist our efforts to ensure compliance. Please check the category that best describes
your racial/ethnic background (optional).
American Indian/Alaska Native _________

Hispanic ________

African-American/Non-Hispanic ________

Asian/Pacific Islander ________

White/Caucasian/Non-Hispanic _________

Other (please specify) _______

(Please see back of this page for remainder of Honors application.)

Please write a brief statement below describing your academic and cultural interests and why you wish to join the Honors Program.

Applicant Signature: ___________________________________________________

Note:

Date: ______________________________

The Honors House in Douglas Hall is reserved for members of the University Honors Program. If you wish to be considered
for residence in the Honors House, please contact the Program Coordinator of the University Honors Program.
RETURN APPLICATION TO:

Online Application

University Honors Program

Northern Illinois University
DeKalb, IL 60115-2854
(815) 753-0694