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Application for New Undergraduate Students Please complete the application using black ink. Please print neatly or type. For office use Please read attached instructions. For U.S. citizens and permanent resident applicants only. Admission cannot be determined until admission application, $30 application fee, test scores and transcripts are received. Section 1: Applicant Information 1 2 Social Security number (optional) Date of birth 3 Your gender Male Female mm/dd/yyyy 4 Legal name Last First Middle 5 Other names and nicknames used on records (including maiden name) 6 Current residence Mailing address City, State Area code and home phone number 7 Cell number Zip/Postal Code County Email address where you’d like to receive WSU updates and enrollment information Permanent residence Mailing address 8 City, State Zip/Postal Code County Place of birth City State Country Please respond to the following questions related to your ethnicity and race. (Optional) 10 Yes No 9 Ethnicity: Are you Hispanic or Latino? What is your race? 11 Are you a U.S. citizen? Yes American Indian or Alaska Native No If yes, skip to section 2 12 Are you a permanent resident, asylee or refugee in the U.S.? No mm/dd/yyyy 13 If you are not a citizen of the U.S., please list: Country of birth Black or African-American White If yes, date your card was issued: Card number Enclose a photocopy of the front and back of your permanent resident, asylee or refugee card. Yes Asian Native Hawaiian or other Pacific Islander 14 Do you currently reside in the U.S. on a non-immigrant visa? If yes, contact International Admissions at (316) 978-3232 or online at Yes Country of citizenship No Section 2: Parent or Guardian Information 15 Parent or guardian (complete only if you are under 21) Name Mailing address Phone City, State Section 3: Kansas Residency Information Parent Guardian Email Zip/Postal Code County (All questions left blank will be considered evidence of a non-Kansas resident.) 16 Are you a resident of the state of Kansas? If Yes No “yes,” when did you begin living continuously in Kansas? 17 If you relocated to Kansas, from where did you move? mm/dd/yyyy 18 Last year, did anyone claim you as a dependent for income tax purposes? Yes If “no,” and you previously lived in Kansas, please state the period of time you lived in Kansas: to mm/yyyy No 19 Are either of your parents or guardians a Kansas resident? If yes, how long? Yes No visit for more information or to apply online. mm/yyyy

2014 Wichita State Undergraduate Admission Application

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