Senior_Citizen_Admission_App_Revised_7_15_16.pdf -...

This preview shows page 1 - 2 out of 2 pages.

Undergraduate Senior Citizen Application A $40.00 non-refundable application fee must accompany your application, payable by check or money order to Wichita State University. This is a one-time fee.SECTION I. Personal Information Legal Name: __________________________________________________________________ Last First Middle Other Date of Birth (mm/dd/yyyy): ___________________ Gender: ____ M ____ F Mailing Address: ______________________________________________________________ Street _____________________________________________________________ City State Zip Telephone: (____) ______-_______ Email:____________________________________ Ethnicity (optional): ____ African-American ____ Asian ____ Hispanic ____ Native American ____ White Are you a Kansas resident? ____ Yes ____ No If “yes,” how long have you lived solely in Kansas? ____ years, from ______ to_______ mm/yy mm/yy Have you lived in Kansas continuously for the past 12 months? ____ Yes ____No Are you a U.S. citizen? ____ Yes ____ No If “no,” are you a____ Permanent Resident (you must present evidence of your statusand date granted) Date Issued: ___________ ID#_________________________ ____ Other: Visa Classification ________________________ (If you are not a U.S. citizen or permanent resident, you must complete an international student application.) (continued on page 2)
SECTION II.
End of preview. Want to read all 2 pages?

Upload your study docs or become a

Course Hero member to access this document

Term
Spring
Professor
NoProfessor
Tags
Wichita Kansas, Wichita State University

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture

  • Left Quote Icon

    Student Picture