74 Wyllys Avenue / Middletown, CT / 06459
summer@wesleyan.edu 860.685.2005
www.wesleyan.edu/summer
Summer Session 2015
Community Scholar Application
General Information
Wesleyan University’s Summer Session offers academically rigorous undergraduate courses that meet daily, Monday
through Friday. The 2015 session dates are May 27-June 25; additionally, Principles of Biology II Lecture & Lab will
meet June 29-July 26.
Enrollment: Enrollment in Wesleyan Summer Session is open to all students who feel they have the academic
qualifications and stamina to complete an intellectually challenging course in a compressed schedule.
Costs: Tuition for Summer Session 2015 is $3,000 per credit. Lab courses are .5 credit; tuition is $1,500. “Working with
R” is .25 credit; tuition is $750. Residency fees for 2015 can be found online at http://www.wesleyan.edu/summer/nonwesleyan-students/housing.html.
Payment: Tuition fees must accompany all registration forms to secure a student’s place; registrations with full payment
will be processed in the order they are received. Housing requests must also be accompanied by full payment in order to
be processed. Payments may be made by check or money order, payable to Wesleyan University.
Financial Aid: Wesleyan University does not offer financial aid to Community Scholars.
Housing and Meals: Housing is available only to students who will be 18 or older on May 26, 2015 who have recently
studied in a residential college or boarding school setting. Students requesting housing must also provide proof of
compliance with the State of Connecticut immunization requirements. Students are not required to live on-campus
during Summer Session. Any student may purchase a la carte meals when the dining hall is open using cash, credit card
or Middletown Cash. Please check the Summer Session website for dining hours and costs.
Identification Card: Students will be issued an identification card called a WesCard to access University facilities,
including the libraries. Students may deposit money on their WesCard for use in University facilities (dining, bookstore,
etc.,) and participating Middletown merchants.
International Students: All application materials for international students must be received by the Summer Session
office no later than April 1, 2015. International students are welcome to apply to take Summer Session courses. An F-1
Student Visa is required. International students should check with their school's Designated School Official to clarify any
visa questions or issues. Please contact Mary Kelly at mgkelly@wesleyan.edu or 860.685.3334 if you would like
additional information.
Transferring Credit to Other Institutions: Visiting students in good standing will be issued official Wesleyan
University transcripts after Summer Session grades are posted. Since each educational institution has its own credit
transfer policy, students should contact their own schools about transferring credits.
Students with Disabilities: Wesleyan University is committed to making its educational programs and facilities
accessible to people with disabilities. Students with a documented disability that requires accommodation should notify
the Office of Disability Resources (lpatey@wesleyan.edu) as soon as possible. All supporting documentation should be
submitted no later than April 24, 2015. Please call the Office of Disability Resources at 860.685.5881 if you have any
questions.
Questions: Please contact us at summer@wesleyan.edu or 860.685.2005 with any questions.
Page 1 of a 2-sided piece
Register for Courses
1. Visit wesleyan.edu/summer to review the course listings and prerequisites, decide which
courses you would like to take, and complete the Registration form.
a. For courses with prerequisites, please email the instructor for approval and include
a printed copy of the email of approval from the instructor with your Registration
form.
2. Complete the Community Scholar Application form (next page of this document).
3. Optional: If you would like to apply for housing, complete the Immunization Compliance
Form and send it, with documentation, to the Wesleyan Health Center (complete
instructions can be found on the form). Email summer@wesleyan.edu to confirm that you
are requesting housing.
4. Send the Wesleyan Summer Session Community Scholar Application, Registration, and
payment directly to:
Wesleyan Summer Session
74 Wyllys Avenue
Middletown, CT 06459
Application checklist
For student use only
✔ FORM
MAIL OR FAX TO:
Wesleyan University
Community Scholars
74 Wyllys Avenue
Middletown, CT 06459
Fax: 860.685.2901
Community Scholar Application
Registration Form
Payment
Immunization Compliance Form and
documentation (if requesting housing)
Page 2 of
a 2-sided piece
University Health Services
327 High Street,
Middletown, CT 06459
Fax: 860.685.2471
74 Wyllys Avenue / Middletown, CT / 06459
summer@wesleyan.edu 860.685.2005
www.wesleyan.edu/summer
Summer Session 2015
Community Scholar Application Form
Complete this form (type or print clearly in ink) and mail with personal statement of interest to:
Wesleyan University Summer Session, 74 Wyllys Avenue, Middletown, CT 06459
Student Information
Student Information (cont.)
___________________________________________________________________________
Last/Family Name
Legal First Name
Middle Initial
Preferred Name
________________________________________
Date of Birth (mm/dd/yyyy)
___________________________________________________________________ ________
Student Email Address
[ ] Male
___________________________________________________________________________
Street Address (Home or Permanent Address)
[ ] Female
Citizenship:
[ ] US citizen/permanent resident
________________________________________
Social Security Number for 1098-T
___________________________________________________________________________
City
State
Zip/Postal Code
Country
[ ] Not a US citizen/permanent resident
___________________________________________________________________________
Home Phone
Student Cell Phone Contact number in case of campus emergency
Is English your native language?
[ ] Yes
[ ] No
___________________________________________________________________________
How did you hear about our program? (e.g., website, Facebook, friend)
___________________________________________________________________________
If currently attending college, institution name
Mailing Address for 1098-T Form
Address same as above? [ ] Yes
[ ] No
___________________________________________________________________________
1098-T Form Address: Street
City, State
Zip/Postal Code
Country
Mailing Address for Transcript
Address same as above? [ ] Yes
[ ] No
___________________________________________________________________________
Transcript Address: Street
City, State
Zip/Postal Code
Country
Emergency Contact
___________________________________________________________________________
Name
Relationship to student
___________________________________________________________________________
Daytime Phone
Evening Phone
If no, specify native language:
____________________
Ethnicity:
Optional – no information provided will be used
in a discriminatory manner. Students may select
from multiple ethnicity categories in a way that
best describes their background.
1. Are you Hispanic or Latino?
[ ] Yes [ ] No
2. Regardless of your answer to the prior
question, please select one or more of the
following groups:
[ ] American Indian or Alaskan Native
(including all Original Peoples of the Americas)
[ ] Asian (including Indian subcontinent and
Philippines)
[ ] Black or African American (including Africa
and Caribbean)
[ ] Native Hawaiian or other Pacific Islander
(Original Peoples)
[ ] White (including Middle Eastern)
Have you ever been found responsible for a disciplinary violation at any educational institution you have attended from the 9th grade (or the international
equivalent) forward, whether related to academic misconduct or behavioral misconduct, that resulted in a disciplinary action? These actions could include, but
are not limited to: probation, suspension, removal, dismissal, or expulsion from the institution. [ ] Yes [ ] No
Have you ever been adjudicated guilty or convicted of a misdemeanor, felony, or other crime? [ ] Yes [ ] No
[Note that you are not required to answer “yes” to this question, or provide an explanation, if the criminal adjudication or conviction has been expunged,
sealed, annulled, pardoned, destroyed, erased, impounded, or otherwise ordered by a court to be kept confidential.]
If you answered “yes” to either or both questions, please provide the approximate date of each incident, explains the circumstances, and a brief paragraph
reflecting on what you learned from the experience.
I have read, understand, and agree to abide by the policies in the Student Handbook as posted at http://www/precollege/oncampus/index.html. I have
read the Honor Code and the Code of Non-Academic Conduct regulations as posted at www.wesleyan.edu/studenthandbook under the header of
University Standards and Regulations and the Undergraduate Agreement and Disclosure Statement at
http://www.wesleyan.edu/studentaccounts/agreementanddisclosure.pdf . I understand and accept my obligations as outlined in the code and I will
uphold Wesleyan University’s standards.
_________________________________________________________________________________________________________
Student Signature (required)
Date
Office Use Only WesID:
Date Entered:
Initials: