University of Nebraska–Lincoln

First Name:   Last Name:

Address:          Address 2:  

   City:    State: Zip Code:

Cell Phone:     Home Phone:

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Gender: Male   Female

Please contact me by:
E-mail
Cell phone
Home phone
Mailing address
Schedule campus visit     Date Preference:

Current Status: Incoming Freshman High School Graduate High School Student College Student - UNL College Student - Other Active Military Army Reserve/National Guard

High School Attended:   Year of Graduation:

College Applying To (select all that apply):
Bryan School of Nursing
Concordia University
Doane College
Southeast Community College
University of Nebraska-Lincoln
University of Nebraska Kearney
Wesleyan University
York College
Other (please specify):

Program of Study/Major:    

I would like more information about: (check all that apply)
ROTC Program
4, 3, and 2 year ROTC Scholarships
Special Nursing Scholarships
Green to Gold

Additional Questions/Comments: