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Are you a student, parent/guardian or counselor?*

Counselor Information

Type of Organization:*

Organization*

Salutation

First Name*

Last Name*

Job Title

Email Address*

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Note: If you would like to join our mailing list, please submit Counselor Contact List form.

Student Information

First Name*

Preferred First Name (If you wish to be addressed by a first name other than the one listed above, please indicate your preferred name in the space below.)

Middle Name

Last Name*

Birthdate*

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If you selected "other", feel free to specify your gender identity here (optional):

Email Address*

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Mailing Address*

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Home Phone

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High School / College Information*

I would enter the University in

as a

Most Recent School

Most Recent School Address

Country

Street

City

Region

Postal Code

Academic Interest

I am interested in the following Northwestern undergraduate schools

Arts and Sciences (Weinberg College of Arts and Sciences)

Communication (School of Communication)

Education and Social Policy (School of Education and Social Policy)

Engineering (McCormick School of Engineering and Applied Science)

Journalism (Medill School of Journalism)

Music (Bienen School of Music)

What musical area of study are you interested in?*

What is your specific instrument or voice part? (Note: instruments listed below correspond to available programs at Northwestern; if you do not see your instrument and have questions, email musiclife@northwestern.edu)*

What is your specific instrument? (Note: instruments listed below correspond to available programs at Northwestern; if you do not see your instrument and have questions, email musiclife@northwestern.edu)*

What is your specific voice part? (Note: voice parts listed below correspond to available programs at Northwestern; if you do not see your instrument and have questions, email musiclife@northwestern.edu)*

Parent/Guardian Information

Salutation

First Name*

Last Name*

Email Address*

When do you expect your student will enter college?*

Note: If you would like to join our mailing list, please submit Parent/Guardian Contact List form.