APPLICATION FOR ADMISSION
ACCELERATED DEGREE PROGRAM
PERSONAL DATA
Name__________________________________________________________________________________________
Last
First
Middle (complete)
Female
Male
Jr., etc.
Maiden name(s) or former last name(s) if any __________________________________________________________________________________
Social Security Number _________________________________________________________ Birthdate ___________________________________
Permanent home address__________________________________________________________________________________________________
Number and Street
City ________________________________________________________ State ________________________ Zip Code ______________________
Home phone _______________________________ Cell phone_______________________________ Work phone ____________________________
Preferred e-mail address __________________________________________________________________________________________________
If currently employed, please provide the following employment information:
Name of employer________________________________________________________________________________________________________
Employer address ________________________________________________________________________________________________________
Number and Street
City ________________________________________________________ State ________________________ Zip Code ______________________
Employer telephone _________________________________
Citizenship:
U.S. citizen
Dual U.S. citizen; specify other country of citizenship______________________________________
U.S. permanent resident visa; citizen of ___________________________________________________________________
Resident Alien
Non-Resident Alien
Other______________________________________________________
If you are not a U.S. citizen and live in the United States, how long have you been in the country?____________________________________________
Resident Alien – One who intends to make the U.S. their permanent residence and who is in possession of a permanent immigrant visa by the Department
of Justice.
Non-Resident Alien – All aliens who have residence in a foreign country which they have no intention of abandoning and whose stay in the United States
is limited to a defined period time and a definite purpose that, by its nature, may be promptly accomplished.
Have you ever been convicted of a crime other than a traffic violation?
Yes
No
If yes, please explain______________________________________________________________________________________________________
FINANCIAL ASSISTANCE
Do you have tuition reimbursement at work?
Yes
Will you apply or have you applied for financial aid?
Will you file for:
TAA/TRA/WIA Benefits
No
Yes
If so, do you plan to use employer reimbursement?
Yes
No
No (applies only to degree-seeking students)
VA Benefits/GI Bill®
Other (explain) __________________________________________
2400 Chew Street • Allentown, PA 18104-5586
Phone: 484-664-3300 • Fax: 484-664-3532 I muhlenberg.edu/wescoe
APP-ADP 11 REV 4414
PERSONAL EVALUATION STATEMENT
Please answer the following questions on a separate sheet of paper. We are very interested in getting to know each of our students as
individuals, and these questions will help us do that.
1. Briefly discuss your experience as a team member in a work environment. Has your organization provided team building or training?
Was this training helpful?
2. In about 500 words, please summarize your educational and career plans and goals. How will attending The Wescoe School enable you
to realize your objectives? Include anything you would like us to know about you.
The following items are optional. No information you provide will be used in evaluating your admissibility.
Hispanic/Latino (Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race)
If you wish to be identified with a particular racial group, please check all that apply:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
I choose not to identify
First language if other than English___________________________ Language spoken at home_________________________
My signature indicates that all information in my application is complete, factually correct, and honestly presented.
Signature_______________________________________________________________________ Date_______________________
MUHLENBERG DISCRIMINATION POLICY: Muhlenberg College is committed to administer all educational policies and activities without discrimination on the basis of race,
color, religion, national or ethnic origin, age, disability, or sex. The admissions process at private undergraduate institutions is exempt from the federal regulation implementing Title IX of the Education Amendments of 1972.
Office Use Only: Advisor________________________________________________ Date ______________________________
Letter:
Accept
Provisional