Online Programs Information Request Form

Thank you for your interest in Northern Illinois University Online. This form can be used to request information on any of our online programs. Please fill out as much information as possible.

Please note, an asterisk(*) denotes a required question.

Basic Information

Student's First/Given Name *

Student's Preferred First Name * (We'll use this in all communications going forward)

Student's Last Name/Surname *

Date of Birth *

Contact Information

Email Address *

Mobile Phone

Permission to Text *

Program Information

Show only:

All Programs

Undergraduate Programs

Graduate Programs

Graduate Certificates

What online program are you interested in studying?

I am a: *

Have you completed an Associate Degree in Nursing?

I am looking to complete a: *

When do you plan to start your online program?

**Hidden Field**