Wesleyan University Request for Information

Personal Information

*First Name

Middle Name

*Last Name

Preferred First Name

*Birthdate

Legal Sex

Gender

Citizenship Status - OPTIONAL

Dual

Non US Citizen

Permanent Resident

US Citizen

Non-US Citizenship Country 1 - OPTIONAL

Non-US Citizenship Country 2 - OPTIONAL

Contact Information

*Email Address

Home Phone (XXX-XXX-XXXX)

Mobile Phone (XXX-XXX-XXXX)

Wesleyan may occasionally communicate with students via SMS messaging. These communications would be transactional in nature and not used for marketing purposes. Do you wish to opt out of any SMS communications?

Yes

No

Permanent Address

Country

Street

City

Region

Postal Code

Is your mailing address different from your permanent home address?

Yes

No

*Mailing Address (if different from permanent address)

Country

Street

City

Region

Postal Code

Academic Information

*Type of Applicant

*Entry Term/Start Date

*Entry Term/ Start Date

Will you be the first in your family to attend and graduate from a 4-year college?

*Current high school or college
(If your school is not listed, insert the school's name, city, and state or country.)

*CEEB Code

Academic Interest (optional)

Parent Information - OPTIONAL

If you wish us to have your parent's contact information, you can complete the fields below. We will not use this information to communicate with your parents about the details of your application.

Parent First Name

Parent Last Name

Parent Email

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