WVSOM Application

Personal Information
Entering Semester: *
Full Name: *

First Name Middle Name Last Name
Preferred First Name: *
Gender: *
If you would like the opportunity, we invite you to share more about your gender identity below:
Date of Birth: *

Month Day Year
Date
Social Security Number:
Mailing Address: *

Street Address

Street Address Line 2

City State / 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 Name Last 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 Name Last 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

City State / Province

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

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

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

Street Address

Street Address Line 2

City State / 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 Native Black or African American Asian Native Hawaiian or Pacific Islander International (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?
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:
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.

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

Cancel of
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: *

Month Day Year
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