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On-the-Spot Decision Day Form

NIU-Naperville
Tuesday, November 13, 2012

Student's First Name:

Student's Last Name:

Address:

(please include an apartment or unit number if applicable)

City:

State:

Zip:

E-mail:

Preferred Phone:

Current School Name:

Intended Major:

High School Graduation Year:

Student's Date of Birth:

How many family members will be visiting with you?

To request disability related accommodations please call ahead to (815) 753-8464 or email blong1@niu.edu at least 1 week prior to the date of your visit.