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APPLICATION FOR NEW UNDERGRADUATE STUDENTS

Please complete the application using black ink. Please print neatly or type.

For office use

For U.S. citizens and permanent resident applicants only. Admission cannot be determined until admission application, $40 application fee, test scores and transcripts are received.

Section 1: Applicant Information 1

2

Social Security number (optional)

3

Date of birth

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)

Yes No 9 Ethnicity: Are you Hispanic or Latino?

11 Are you a U.S. citizen? If yes, skip to section 2

Yes

10 What is your race? American Indian or Alaska Native

No

Asian

Native Hawaiian or other Pacific Islander

Black or African-American

White

12 Are you a permanent resident, asylee or refugee in the U.S.? 13 If not a permanent resident, asylee or refugee in the US, have you been If yes, enclose a photocopy of the front and back of your permanent approved for the Deferred Action for Childhood Arrivals (DACA)? resident, asylee or refugee card.

Yes

Yes

No

14 If you are not a citizen of the U.S., please list: Country of birth

15

No

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 16 Parent or guardian (complete only if you are under 21) Name

Phone

Mailing address

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.)

17 Are you a resident of the state of Kansas? Yes No 18 If you relocated to Kansas, from where did you move?

If “yes,” when did you begin living continuously in Kansas?

If “no,” and you previously lived in Kansas, please state the period of time you lived in Kansas:

mm/dd/yyyy

mm/yyyy

to

19 Last year, did anyone claim you as a dependent for income tax purposes?

Yes

No

If yes, please indicate name, relationship, city, and state.

20 Are either of your parents or guardians a Kansas resident?

Yes

No

If yes, how long?

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

mm/yyyy

2016-17 Wichita State Undergraduate Admission Application  
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