Wesleyan University Request for Information

Form fields marked with * are required.

Student Contact Information

PLEASE NOTE: Preferred name will be used on all email/SMS communications
Legal first name will be used on physical mailings/admission documents

*Legal First Name

Preferred First Name

*Legal Last Name

*Birthdate

*Email Address

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

Student Demographic Information (Optional)

Legal Sex

Gender

Citizenship Status - OPTIONAL

US Citizen

Dual US/Other

Permanent Resident

Non US Citizen

Non-US Citizenship Country 1 - OPTIONAL

Non-US Citizenship Country 2 - OPTIONAL

Student 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?

Would you like to receive information about financial aid?

Yes

*Current high school or college
(Please use box to search for your school. You can search by school name or location. If your school is not listed, type in the school's name.)

*CEEB Code

Academic Interest 1 (optional)

Academic Interest 2 (optional)

Parent/Guardian 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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Wesleyan University Request for Information