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Information Request Form

Join our mailing list to learn more about Wesleyan.

Form fields marked with * are required.

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Personal Info

*Last Name

*First Name

Middle Name

*Birthdate

*Birthdate

*Legal Sex

Gender

Contact Info

*Email Address

Home Phone (XXX-XXX-XXXX)

Mobile Phone (XXX-XXX-XXXX)

*Mailing Address (if different from permanent address)

*Mailing Address (if different from permanent address)

Country

Street

City

Region

Postal Code

*Is your mailing address different from your permanent home address?

*Is your mailing address different from your permanent home address?

Yes

No

Permanent Address

Permanent Address

Country

Street

City

Region

Postal Code

Academic Info

*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.)

Academic Interest 1

Academic Interest 2 (optional)

Academic Interest 3 (optional)