Trailblazer Scholars Program Application

Trailblazer Scholars Application

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Name(Required)

First Last

Date of Birth

NDMU Student ID #

Cell Phone

NDMU Email(Required)

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

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First Year

Sophomore

Junior

Senior

Name of High School attended:

Intended Major

NDMU 100 Advisor

I will live on campus

I will live at home and commute

Extracurricular activities and interests

Family Information

The Trailblazer program provides workshops specifically for your parents and family. Please provide a little bit of information about them so that information about workshops can be sent directly to them.

Name

First Last

Parent(s) name (s)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please comment on your particular questions and concerns as you begin college.

In what ways do you think the Trailblazer Scholars program could help you to be successful in college and to reach your goals?

Additional information about you and your interests that you would like to share with the Trailblazer Director:

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