WESTERN SHORES INSTITUTE INC. (WSI)
MASTER AND EXECUTIVE CERTIFICATE PROGRAMS
APPLICATION FOR ADMISSION
Application Information
Applications for admission into a Master Certificate Program are accepted at any time. Admission is
competitive and is based on the complete application. You can fill this form out in Word and save it, and email it as an attachment to admissions@wsi-edu.info, or you can print it out and send it to the following
address:
Western Shores Institute, Inc.
Office of Admissions
10383 Southern Maryland Blvd
PO Box 81
Dunkirk, Maryland 20754-0081
Transcripts should also be sent to the same address. If you have any questions, please contact
admissions@wsi-edu.info.
Please visit the www.wsi-edu.info admissions webpage for application fee. Please note: Admission
decisions may take up to 3 weeks. If you are accepted into your desired program, you will be sent
registration information.
Eligibility Requirements
Entering students must (at a minimum):
 have a high school diploma
 have 4 or more years of work experience or 2 or more years of post-high school education.
 not have been academically dismissed from any educational program within the last 12 months.
Unofficial Transcripts should be included with your application if available. Official College Transcripts will
be required. WSI is a CLEP® score recipient (score recipient code 4277).
Non-Discrimination Policy
WSI does not discriminate in its educational programs, activities or employment on the basis of race, color,
age, sex, religion, national and ethnic origin, or handicap. It is the student’s responsibility to notify the
Institute of special disability needs as quickly and completely as possible. The Institute is required to
provide reasonable modifications or accommodations which may be necessary for a disabled student to
have equal access to education and educational services.
For more information, please visit www.wsi-edu.info, under the Policies and Procedures tab.
©2010-2012 WSI Inc. All Rights Reserved.
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Application for Admission
Please Note: Attach a separate Word document if you need additional space
/ID:
Master/Executive Certificate Program you are applying for
Last Name
For Admissions Use Only (Leave Blank)
First Name
Social Security Number
(last 4 digits ONLY):
XXX-XX-
MI
E-mail:
Home Address:
Street
City, State, Zip Code (International Students, please include country)
Home Telephone Number: (xxx) xxx-xxxx
International Students: please include country code
Date of Birth (MM/DD/YYYY)
Cell Phone Number: (xxx) xxx-xxxx
International Students: please include country code
Secondary E-mail Address
High School Name
Address:
Street
City, State, Zip Code (International Students, please include country)
Current Status: Select One
Sex: Select One
High School Telephone Number
(xxx) xxx-xxxx
Schools/Colleges/Universities Attended, Dates/Major (begin with the most recent, and move backwards from there):
Are you currently employed or are you a student at another school? Select One
If yes, please describe:
©2010-2012 WSI Inc. All Rights Reserved.
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Personal Statement
Applicants must submit a personal statement (200 words or more) that describes your future plans,
expectations, and aspirations. This is an opportunity for you to demonstrate your writing skills as well as
share your academic and professional goals.
©2010-2012 WSI Inc. All Rights Reserved.
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Background Information
Please briefly answer the following questions:
How will completing this program help you?
What else should we know about you or your background?
What is your primary language?
If not English, please understand that course materials are only available in English.
Statement of Accuracy
To the best of my knowledge, all information submitted within this application is true and accurate. By
submitting this application for admission, I automatically waive any right to have access to the application
or materials relating to the application as part of my record at the College.
Student’s Signature (If signing electronically, use your full legal name as your signature):
Date:
Western Shores Institute Inc.
admissions@wsi-edu.info
©2010-2012 WSI Inc. All Rights Reserved.
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Affirmative Action Information Sheet
Western Shores Institute does not discriminate in its educational programs, activities or employment
on the basis of race, color, age, sex, religion, national and ethnic origin, or handicap. The federal
government requires us to maintain records on the sex and race/ethnic origin of our applicants, and
that we invite applicants to identify their disabled or veteran status. In order to comply with these
requirements, the Institute requests that you supply the information requested below.
Submission of this information is voluntary and will be kept confidential and separate from your
application, except as required by law. Your cooperation is greatly appreciated.
Date of Birth:
/
/
Sex: (Male/Female):
Referral Sources:
Friend/Relative
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Employed at WSI
Media (Radio/TV)
Other
Ethnic Origin:
Undeclared or Unknown
Native American or Alaskan Native
Black/African American (not of Hispanic Origin)
Asian or Pacific Islander
Hispanic, Latin American
White (not of Hispanic Origin)
Citizenship:
Non-resident w/ Visa – Specify type and expiration date:
U.S. Citizen
Permanent Resident or Resident Alien
Other
Veteran Status:
Non-Veteran
Veteran – Specify Service:
Reservist or Active Duty – Specify Service:
Disabling Condition:
No Disability
Disabled Veteran
Disability/Impairment – Specify:
Other – Specify:
©2010-2012 WSI Inc. All Rights Reserved.
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