Form A
APPLICATION FOR ADMISSION TO GRADUATE SCHOOL
Wichita State University
Include application fee payable to Wichita State University. Fee amount: $75.
1.
Previous last name(s) ____________________________________
Last or family name ________________________________
First or given name ________________________________
Middle name ________________________________________
2. Social Security number* ______________________________ myWSU ID number (if known) _________________________________
* optional, but needed if applying for Federal financial aid
3.
Gender: • Male • Female
4. Date of birth (mm/dd/yy) ____________________________________
4. Please respond to the following questions related to your ethnicity and race (optional)
1. Are you Hispanic or Latino? • Yes • No
2. Select one or more of the following racial groups.
Asian
• American Indian or Alaskan Native
• Black or African American
• Native Hawaiian or Pacific Islander
• White
5.
Are you a U.S. citizen? • Yes • No If “No”, please identify the following:
Country of citizenship: ____________________________________ Country of birth: ________________________________________
Are you a permanent resident of the U.S.? • Yes • No
(If yes, you must provide a notarized copy of your permanent resident card along with the application and application fee.)
If you are in the United States on a visa, what visa type do you hold? ____________________________________________________
If a student visa, please indicate the school that issued your I-20 form: __________________________________________________
6.
Kansas residency information. All questions left blank will be considered evidence of a non-Kansas resident:
6a. Are you a resident of Kansas? • Yes • No If yes, when did you begin living continuously in Kansas? _________________
6b. Have you lived solely in Kansas for the past 12 months? • Yes • No
6c. Are you in Kansas primarily to attend school or perform military service with your home in another state? • Yes • No
6d. If you are not a resident of Kansas, in what state are you a legal resident? __________________________________________8e. 7e.
6e.Are you a legal Kansas resident who was out of state for the primary purpose of school or military service? • Yes • No
6f. If you have resided in Kansas in the past, please indicate your dates of residence:
Address information: (International applicants must provide BOTH a mailing address and permanent foreign address.)
Mailing address:
Street _______________________________________
Street _______________________________________
City-state/country ______________________________
Postal or zip code ______________________________
Permanent address:
Street ______________________________________________
Street ___________________________________________y-
City-state/country _____________________________________
Postal or zip code ____________________________________
Phone number__________________________ Home email address:__________________________________________________
continued
No
Military Service Information
7a. Have you ever served in any branches of the U.S. Military? Yes No
7b. Are you currently active duty military or a member of the National Guard or Reserve components? Yes
7c. Are you a military dependent? Yes No
7d. If YES to any 7a-7c, please enter where you are stationed: ______________________________________
7.
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8.
