LPN-BSN Intent to Enroll Form

LPN-BSN Intent to Enroll
The Office of Admissions welcomes students that have been accepted and plan to enroll at West Virginia Wesleyan to complete the Intent to Enroll Form for entrance into the LPN-BSN Program. This form is used to secure your place in the incoming class. Once completed, you will be redirected to a page where you can submit your enrollment deposit.
Name*

First NameLast Name
Preferred Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Social Security Number
Date of Birth*

MonthDayYear
Home Phone Number*

Area CodePhone Number
Cell Phone Number*

Area CodePhone Number
E-mail*
Legal Sex*
I will enroll at West Virginia Wesleyan beginning:*
LPN-BSN Program Type*

Full-TimePart-Time
Upon submission of the Intent to Enroll and Housing Request Form you will be redirected to a page where you will be able to make your $200 enrollment deposit . I understand this form will only be processed if the $200 enrollment deposit is received*

I agree to pay the $200 enrollment deposit
Should be Empty: