Prospective Student Information Request Form

Thank you for your interest in Michigan Tech.
Please fill out the following form
and we will respond to your request as soon as possible.

Information Request Form

Please send information about Michigan Tech to:
Date (mm/dd/yy)
Name (First, middle initial, last)
Address

City		, State
ZIP or Country code		Country
Telephone number (include area code)
Email address		, IM address
Gender		Male Female
GPA (on a 4.0 scale)
Birth date
High School Graduation Year
Current school name
School's location		City , State , Country
Intended college major
Other interests (outside the classroom)


Submit Form to Michigan Tech Admissions Office and the Physical Education Department

Exercise Science, Health and Physical Education Department
Exercise Science Degree Program
Michigan Technological University
1400 Townsend Drive
Houghton, Michigan 49931-1295

© 2006 Michigan Technological University
Last modified on: 05/05/2006

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