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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 wichita.edu/international.

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 wichita.edu/admissions for more information or to apply online.

mm/yyyy


2014 Wichita State Undergraduate Admission Application