Skip Navigation

University of Nebraska–Lincoln

Extended Education & Outreach

Distance Learning Anytime, Anywhere

Request Information

Required fields are marked with a red asterisk *
First Name*: MI: Last Name*:
Gender: Male Female    

Address 1*:
Address 2:
City*:
State*:
ZIP Code*:
Phone:
E-mail*:
How would you prefer to be contacted?
Phone E-mail

How did you hear about us?*: (select all that apply)

Advertisement
Brochure/Bulletin
Direct Mail
Referred by Someone:
Conference or Information Session
Web/Internet search
Other, please specify :




Who are you?*: (select all that apply)
I am a student
I am a parent/guardian
I am a school guidance counselor/adviser
I am a school principal or administrator
I am (or will be) a proctor
Other, please specify:



What is your primary reason for contacting us?*: (select all that apply)

Personal enrichment or challenge
I plan to attend UNL
My local school doesn’t offer the course(s)
Send me updates on your courses/programs
I want information on becoming a partner school
Other, please specify:




Please send me information about other educational opportunities from the University of Nebraska-Lincoln*: (select all that apply)
Independent Study High School
College Independent Study
Summer Independent Study (distance option for undergraduate students in the Lincoln area)
UNL Undergraduate Admissions
Graduate Distance Degrees, including Masters, Doctoral and Certificate programs



What high school are you associated with?*:



 
Additional Questions or Comments: