Special Student Application
Name
*
First Name
Last Name
Preferred Name
*
Middle Name
*
If previously identified under a different name, please provide the name
Social Security Number
*
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Male
Female
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Are you a veteran?
*
Yes
No
Are you a West Virginia Wesleyan College Employee Tuition Waiver Candidate?
*
Yes
No
Academic Information
Name of High School
*
Graduation Date
*
College(s) & Dates Attended
*
Have you ever been dismissed for academic reasons from any school?
*
Yes
No
If yes, which institution?
I am a degree candidate at (list institution):
My major is:
I earned a
list degree
degree at
list institution
.
I wish to enroll for:
*
Credit
Audit (must have permission from VP of Academic Affairs)
Planned year of study
*
Please Select
2025
Planned term of study
*
Please Select
May-Term
Summer
Fall
My signature indicates that all information contained in my application is complete, factually correct, and honestly presented.
*
Submit
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