EmailMe Form - Stay Connected Program

Name *

First Last

Student ID *

Phone

### - ### - ####

Physical Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Current Internet Service Provider (if applicable)

Attach a recent bill from your current Internet Service Provider (if applicable)

For more information or if you have any questions, e-mail student_opportunities@menominee.edu.