Jamaican UNDERGRAD App.pdf - WESTERN Undergraduate...

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Undergraduate
Application for Admission
Please attach $5 5 application fee.
Your failure to provide complete, accurate, and truthful information on this application will be grounds to deny or withdraw your admission,
or dismiss you after enrollment.
1.
__________________________________________________________________________________________________
Last Name Suffix (Jr., III, etc.) First Name Middle Name Former last name, if any
2. Term of Entry:

-

(i.e. 2012-50 = 2012 Summer)
3. Entrance status and Program:
____ Jamaican EABSED MGRJ2
(please check one)
4. Attendance: ____ Full-time ____ Part-time
5. Have you ever applied for admission at WCU? ____ Yes ____ No If yes, please indicate when: _________________________
Have you ever attended WCU? ____ Yes ____ No If yes, please indicate when: ______________________________________
6. Gender: ____ Male ____ Female
7. Ethnicity: __________
W = White, Not of Hispanic Origin B = Black, Not of Hispanic Origin H = Hispanic Americans
M = Multiracial I = American Indian/Alaskan Native O – Asian or Pacific Islander X = International/Other
Gender/Ethnicity are requested for federal/state reports. Western Carolina University does not practice or condone discrimination against applicants on the
basis of ethnicity, color, national origin, religion, gender, age, sexual orientation, or disability.
8. E-mail Address: _______________________________________________________________________________________________
9. Date of Birth ______________/________/________________ Place of Birth: __________________________________ __________
Month Day Year City State
10. Social Security Number __________________________________
( Providing this information is voluntary. It is used only for record-keeping purposes.)
11. Are you a US Citizen? ____ Yes ____ No
12. If not a US citizen, please list Country of citizenship : ________________________________________________________________
Residency and Contact Information
– Please complete all information in this section to aid with initial residency classification.