WESTERN
Undergraduate
Application for Admission
Carolina University
Please attach $50 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
-
2.
Term of Entry:
3.
Entrance status and Program:
(please check one)
____ Dual Enrolled
____ Highlands Biological
____ Landmark Learning
____ Penland
4.
Attendance: ____ Full-time
5.
Have you ever applied for admission at WCU? ____ Yes
Middle Name
Former last name, if any
80 = Fall
50 = Summer
10 = Spring
(i.e. 2012-50 = 2012 Summer)
GNNON-HISD
GNNON TST
GNNON TST
GNNON TST
____ Part-time
Have you ever attended WCU? ____ Yes
____ No
____ No
If yes, please indicate when: _________________________
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 __________________________________ (This information is required prior to course registration.)
11. Are you a US Citizen?
____ Yes
____ No
12. If not a US citizen, please list Country of citizenship: ____________________________________________________________ and
VisaType, Number and Expiration Date or Permanent Resident Number and Expiration Date:
_____________________________________________________________________________________________________________
Residency and Contact Information – Please complete all information in this section to aid with initial residency classification.
If additional information is required, you will be notified.
13. __________________________________________________________________ __________________________________________
Mailing Address
City
__________________________________________ _______________________________ __________________________________
State
Zip
14. Have you lived in North Carolina for at least 12 consecutive months?
County
_____ Yes
_____ No
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15. Telephone
Cell
(____________) ________________________________________
(____________) ________________________________________
Emergency Contact Information
16. Emergency contact’s full name: _________________________________________________ Relationship to you: ________________
17. ____________________________________________ __________________ _____ _____________ _________________________
Emergency contact’s street address/PO Box
City
State
Zip
Area code/Phone number
High School Information
18. List all high schools attended, whether or not you completed a term (list most recent first).
High School Attended
19. Have you ever taken the SAT or ACT?
City
____ Yes
____ No
State
Graduation Date
(month/year)
If yes, give date __________________________________________
College Information
20. List all colleges you have attended in the order of attendance, with the most recent listed first. This must include any institution at which
you registered for classes (even if a withdrawal was granted) and those which you will attend prior to enrollment at WCU. Dual
Enrollment work completed while in high school should also be listed here. Failure to list prior college course work could result in
denial of admission or dismissal.
Date Attended
College Attended
City
State
From
Degree
To
Received
21. Are you eligible for readmission to the last college you attended, regardless of graduation status. (did you leave in good academic and
social standing?) ____ Yes ____ No If you answered “no” to this question, please explain below or attach a separate sheet.
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22. Your “yes” answer to one or more of the following questions will not necessarily preclude your admittance. However, your failure to
provide complete, accurate, and truthful information will be grounds to deny or withdraw your admission, or to dismiss you after
enrollment. For the purpose of the following six questions, “crime” or “criminal charge” refers to any crime other than traffic-related
misdemeanors or infractions. You must, however, include alcohol or drug offenses whether or not they are traffic related.
(Please check one answer for each question.)
1.
Have you ever been convicted of a crime? ____ Yes ____ No
2.
Have you entered a plea of guilty, a plea of no contest, a plea of nolo contendere, or an Alford plea, or have your received a
deferred prosecution or prayer for judgment continued, to a criminal charge? ____ Yes ____ No
3.
Have you otherwise accepted responsibility for the commission of a crime? ____ Yes ____ No
4.
Do you have any criminal charges pending against you? ____ Yes
5.
Have you ever been expelled, dismissed, suspended, placed on probation, or otherwise subject to any disciplinary sanction by any
____ No
school, college or university? ____ Yes ____ No
6.
If you have ever served in the military, did you receive any type of discharge other than an honorable discharge?
____ Yes ____ No
____ Currently serving
____ Never served
If you answered “yes” to any of the questions in #23 above, please explain the circumstances below or attach a separate sheet.
You must promptly notify the Admission Office in writing of any criminal charge, any disposition of a criminal charge, or any school,
college, or university disciplinary action against you, or any type of military discharge that occurs at any time, prior to your enrollment, after
you submit this application. Your failure to do so will be grounds to deny or withdraw your admission, or to dismiss you after enrollment.
I understand that the university encourages its students, faculty, and staff to display the following traits of citizenship: behavior characterized
by honesty, integrity, and responsibility; service to others; awareness of and sensitivity to the concerns of diverse people and cultures; and
commitment to stewardship of the natural and cultural environment. By completing and submitting this application, I agree to the policies
and regulations of Western Carolina University. To the best of my knowledge, the information I have given is true and accurate. I understand
my failure to provide complete, accurate, and truthful information on this application will be grounds for refusal of admission, cancellation of
admission, or dismissal from the university.
Applicant signature (required) ______________________________________________________ Date _____________________________
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