This is not an application for admission as a degree-seeking student. Prospective degree candidates must apply through
the Washington and Lee Office of Admission. Complete all items and obtain all required signatures in the order indicated
before returning the completed form to the University Registrar's Office.
NAME: Date of Birth:
k) (Home/Cell)
I am applying for Term (select only one): Fall Winter Spring Year:
My regular work schedule is
Please check the appropriate category of eligibility.
D Operations Staff (Facilities, Dining Services, Public Safety) D Spouse/Domestic Partner*
D Administrator D Faculty D Office Staff
NOTE for Spouse/Domestic Partner: Please provide name of the eligible Washington and Lee employee:
Previous Institutions. For initial application, provide official transcripts from secondary schools and all colleges.
Secondary School Name & Location:
College/University Names & Locations:
Course information. Discuss course selection with the University Registrar and the academic department head(s).
Subject Catalog # Section # Title Meeting Times and Days
1) _______ ______ ______ __________________________________________ _________________________
2) _______ ______ ______ __________________________________________ _________________________
I understand th
at I am held to the same academic, Honor System, and student conduct standards as are all W&L
students, and that I am subject to the same disciplinary oversight by the faculty, Executive Committee, and other conduct
bodies. I also understand that the value of this benefit may be taxable.
Applicant's signature Date
1) ________________________________________ 2) ________________________________________
Supervisor (not required for spouse/partner) Executive Director of Human Resources
3) ________________________________________ 4) ________________________________________
Course1 Instructor Course 1 Academic Department Head/Assoc. Law Dean
5) ________________________________________ 6) ________________________________________
Course 2 Instructor Course 2 Academic Department Head/Assoc. Law Dean
7) ________________________________________
Office Use: Initial App? _____ ID_____________ Cmpl Date ____________
University Registrar copies: HR; initial app to President of the Student Body Executive Committee
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