UNIVERSITY HONORS APPLICATION
(New Students/Applicants with Freshman Status—Academic or Social)
NAME Last, First Initial
Z-ID# Z_____
PERMANENT ADDRESS
Street City, State Zip
PHONE NUMBER
Primary Phone
☐ Cell ☐ Home
Other Phone (optional)
☐ Cell ☐ Home
NAME(S) OF ☐PARENT(S), ☐GUARDIAN(S) OR ☐SPOUSE (please select and enter one category only)
Enter Name(s)
BIRTH DATE
mm/dd/year
EMAIL
Enter Email
GENDER
☐Male ☐Female
GRADUATION DATE Semester/Year
High School Rank # out of #
HIGH SCHOOL Name City, State
ACT SCORES: English ___ Math ___ Reading ___ Science ___ Writing ___
EDUCATION:
Expected departmental major at NIU Major Department
Transfer or Advanced Credit: Institution(s) Name Credits: ___
GPA: ___
EXTRACURRICULAR ACTIVITIES
LEADERSHIP AND INVOLVEMENT
List all activities and organizations in which you have participated in high school. Indicate your level of
involvement and specific accomplishments for each activity and organization listed (e.g., Student Council, Key
Club, National Honors Society, Thespians, Band, Orchestra, etc.)
Indicate special activities in which you have participated and honors which you have received at the local,
regional, state and national level (e.g., regional art show, state science fair, national academic bowl, etc.)
COMMUNITY SERVICE
List community service in which you have been involved and indicate your level and duration of involvement and
any special accomplishments.
WORK EXPERIENCE
(Job title, description and hours per week; how long have you held the job?)
WORK EXPERIENCE
Please check the category that best describes your racial/ethnic background (optional).
Are you Hispanic, Latino, or Spanish Origin?
☐Yes, I am Hispanic or Latino/Latina
☐No, not of Hispanic, Latino/Latina
Hispanic or Latino/Latina means a person of Cuban, Mexican, Puerto Rican, South or Central American, or other
Spanish culture or origin, regardless of race.
Please select the option which best describes your race (optional). You may check more than one box.
☐American Indian or Alaska Native
A person having origins in any of the original peoples
of North and South America (including Central
America), and who maintains a tribal affiliation or
community attachment
☐Asian
A person having origins in any of the original
peoples of the Far East, Southeast Asia, or the
Indian subcontinent including, for example,
Cambodia, China, India, Japan, Korea, Malaysia,
Pakistan, the Philippine Islands, Thailand and
Vietnam.
☐Black or African-American
A person having origins in any of the Black racial
groups of Africa
☐Native Hawaiian or Pacific Islander
A person having origins in any of the original
peoples of Hawaii, Guam, Samoa, or other Pacific
Islands
☐White/Caucasian/Non-Hispanic
A person having origins in any of the original peoples
of Europe, the Middle East or North Africa
☐Other (please specify)
Click here to enter text.
ESSAY: Submit a one-page essay on an important experience(s) which has contributed positively to your growth
as an individual. Include the essay with this application.
ELECTRONIC SIGNATURE: First and Last Name
Date: mm/dd/year
☐By checking this box I agree that all statements provided are true and any falsifying information could result in
removal from the University Honors Program.
NOTE: The Honors House in New Hall – East is reserved for members of the University Honors Program. If you
wish to be considered for residence, please contact the Assistant Director for Programming of the
University Honors Program.
Please complete and submit
application to University Honors by
email at honors@niu.edu, mail, or fax
at 815-753-9507.
University Honors Program
Attn: Associate Vice Provost
Northern Illinois University
DeKalb, IL 60115
(815) 753-0694