Dual Enrollment Application Form

Personal Information

Last Name *

First Name *

Middle Name

Date of Birth: *

Cell Phone *

Phone Number

Email Address *

Have you attended WAU Before? *Yes attendedNever attended

Please give the last attended year

WAU Student ID(if applicable)

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Citizenship *

Social Security Number *Without dash or space in between the numbers, If you don't have it - Please put 9 zeros.

Gender *

Race

Ethnicity

Religious affiliation

Name of the Conference

Academic LevelUndergraduate(UG)

Student Type

Anticipated Entry Term

Academic Program of Interest

Enter the Name of the School *

Parent First Name *

Parent Last Name *

Parent Email ID *

Parent Phone Number *