WVSOM Application

Personal Information
Entering Semester:*
Full Name:*

First NameMiddle NameLast Name
Preferred First Name:*
Legal Sex:*
Preferred Pronouns
If you would like the opportunity, we invite you to share more about your gender identity below:
Date of Birth:*

MonthDayYear
Date
Social Security Number:
Mailing Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email:*
example@example.com
Home Phone:*
Please enter a valid phone number.
Cell Phone*
Please enter a valid phone number.
Do you prefer to be texted?*
Country(ies) of Citizenship:*
If not a US citizen: Are you a permanent resident of the US?
If not a US citizen: Are you a resident alien?
Have you ever been convicted of a misdemeanor and/or felony?*
If yes, please describe:*
Indicate your housing preference:*
Intended Major:*
Your Family
Mother's Full Name:

First NameLast Name
Mother's E-mail Address:
example@example.com
Mother's Occupation:
Mother's Employer:
Mother's Work Phone:
Please enter a valid phone number.
Name of College attended (if any):
Father's Full Name:

First NameLast Name
Father's E-mail Address:
example@example.com
Father's Occupation:
Father's Employer:
Father's Work Phone:
Please enter a valid phone number.
Name of College attended (if any):
Please select if parents are:*
If not with both parents, with whom do you make your permanent home?
Is the address the same as your mailing address?*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
West Virginia Wesleyan Connections
Do you have any relatives who have graduated from West Virginia Wesleyan?*
Name*

First NameLast Name
Relationship to You:*
Grad Year:*
Name

First NameLast Name
Relationship to You:
Grad Year:
Education Information
Current High School:*
Grad Year:*
High School Address:*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
List any other secondary schools that you have attended:
Optional Information
List any health factors or special needs that should be called to our attention:
Colleges and universities are asked by many, including the federal government, accrediting associations, college guides, newspapers, and our own college/university communities, to describe the racial/ethnic background of our students and employees. In order to respond to these requests, we ask you to answer the following two questions:
Do you consider yourself to be Hispanic/Latino?
In addition, select one or more of the following racial categories to describe yourself:

American Indian or Alaskan NativeBlack or African AmericanAsianNative Hawaiian or Pacific IslanderInternational (F-1 Student Visa)White
Religious Background
Religious Denomination:
Are you a member of the United Methodist Church?
Activities
Activity:
Positions held, honors, etc.:
Grade Level (9, 10, 11, 12):
Do you plan to participate in college?
Activity:
Positions held, honors, etc.:
Grade Level (9, 10, 11, 12):
Do you plan to participate in college?
Activity:
Positions held, honors, etc.:
Grade Level (9, 10, 11, 12):
Do you plan to participate in college?
Activity:
Positions held, honors, etc.:
Grade Level (9, 10, 11, 12):
Do you plan to participate in college?
List additional activities here:
Academic Awards or Honors
Briefly describe any scholastic distinctions or honors you have received beginning with the ninth grad. (National Honor Society, Girls/Boys State, Science Fair Competition, etc.)
Please list additional colleges you are considering:
Transcripts (attach here or email later to admissions@wvwc.edu)

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Test Scores (attach here or email later to admissions@wvwc.edu)

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Please upload letters of reference/recommendation from two of the following or email them to admissions@wvwc.edu: A. High School Administrator (principal, assistant principal, or a guidance counselor) B. Science or Math teacher whom can detail the students' academic performance or C. Physician.

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Please upload an essay to discusses your future plans and aspirations in becoming an osteopathic physician or email it to admissions@wvwc.edu.

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Statement of Certification
In signing this formal application, I signify that all of the information I have provided on the application is authentic, accurate and complete. I understand that failure to do so may result in separation from the College.
Signature:*

Clear
Date:*

MonthDayYear
Date
Should be Empty:

Personal Information

Your Family

West Virginia Wesleyan Connections

Education Information

Optional Information

Religious Background

Activities

Academic Awards or Honors

Statement of Certification