DUAL CREDIT Have you taken college level credit courses as a High School Student? Yes No
ENTRY DATE What term are you applying for? Fall (August) Spring (January) Summer
Have you attended another Purdue campus? Yes No If yes, please specify last campus attended ________
DEGREE INTENT Do you plan to complete a degree at Purdue Northwest? Yes No
MAJOR Intended major ____________________________________ Concentration _________________
(2nd choice) Intended major _____________________________ Concentration _________________
* Nursing Deadline of February 1 for all applicants who wish to be considered for the following Fall semester direct admission or October 1 for
Spring semester direct admission. **If you currently hold an LPN License please submit a copy with your application.
HOME CAMPUS Please indicate the location at which you plan to attend the majority of your classes. Hammond Westville
HIGH SCHOOL INFO _________________________________________________________________________
Name City State
Graduation Year __________ GED or TASC completion date (if applicable) ________________
Are you a current recipient of Free or Reduced Lunch? Yes No (Please submit verication from Guidance Counselor)
SAT/ACT Indicate all date(s) you took or will take the SAT, rSAT and/or ACT __________ __________ ___________
SAT or rSAT (mo/yr) ACT (mo/yr) Neither
APPLICANT TYPE Freshman – I have graduated, or will graduate from high school and I have not earned college credit after graduating.
Transfer – I have attended a college or university after graduating high school.
Readmission – I previously attended a Purdue campus but was academically dropped from the university.
Re-Entry – I have previously attended a Purdue campus and was a student in good standing.
Regional Campus Transfer – I am currently attending a Purdue location and want to transfer permanently.
Non-Degree – I am pursuing courses for personal enrichment or am a visiting student taking courses at PNW.
Graduate Plus – I have completed a baccalaureate degree and plan to take additional undergraduate courses.
HIGHER EDUCATION Have you ever attended or are you currently attending another college? List the full name of all colleges you have attended.
Failure to indicate all institutions attended may result in denial of admission and/or termination of enrollment.
Institution City & State Dates attended Degree(s) earned Year received
If you have college credits from a non-Purdue University you must submit ocial transcripts from all colleges attended.
CAMPUS HOUSING Are you interested in living on campus? Yes No
EMERGENCY CONTACT __________________________________________________(_______)_______________
Last Name First Relationship Phone
Number/Street City State Zip
AUTHORIZATION I certify that all the information provided is accurate and true. I understand that falsied information may result in denial of admission and/or
SIGNATURE termination of enrollment at Purdue Northwest. I arm, under the penalties of perjury, that the following representations, including information
related to my citizenship status and/or presence in the United States, are true. I authorize Purdue Northwest to report my admission status and
academic program to my high school counselor for the purpose of curriculum development and improvement of instruction. I authorize secondary
and post-secondary schools I have attended to release information needed by Purdue Northwest to process and verify my application. I authorize
Purdue Northwest Division of Financial Aid to release, as it deems appropriate, information on my academic program (including grades) and the
amount of any nancial award I may receive to agencies, institutions, and others involved in providing funds for my education. I agree to abide
by the policies, rules and regulations of PNW.
Signature of Applicant Date Phone (during business hours)
A complete application will ensure the processing of your application as quickly as possible. All records submitted become the property of Purdue University.
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