First Name:
Last Name:
APPLICANT INFORMATION:
Middle Name:
Preferred Name:
Maiden Name:
Gender:
Male
Female
Permanent Address:
City:
Country:
State:
Canada:
Zip:
Date of Birth:
Social Security Number:
Are you a U.S. citizen or permanent resident?
Yes
No
If no, citizen of what country?
Type of Visa:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
Mailing Address:
City:
State:
Country:
Zip:
______________________________________________________________________________________________
Telephone Number (No hyphens):
Alternate Telephone Number:
Cell Phone Number:
Email Address:
______________________________________________________________________________________________
The items in this section are optional
Marital Status:
Religious Affiliation:
______________________________________________________________________________________________
Racial/Ethnic Information:
Prinicipal language in home if other than English:
Please specify any special accommodations you have that
should be brought to the attention of the College:
ADMISSIONS INFORMATION
I am applying as:
Semester to begin:
Status:
Intended Major:
Housing:
I have applied to the following colleges:
How did you learn about Iowa Wesleyan College?
Why did you apply to Iowa Wesleyan College?
What factors will be most important in your college decision?
Will you be filing the Free Application for Federal Student Aid (FAFSA) form?
Yes
No
_____________________________________________________________________________________________
EDUCATION HISTORY
High School Name:
Date of Graduation:
High School Address:
State:
Zip:
School Counselor:
Counselor's Email Address:
Do you have a GED?
Yes
No
Have you taken the ACT or SAT 1?
ACT or SAT I Date:
ACT or SAT I Score:
International students:
Have you taken the TOEFL, IELTS, EINKEN, or STEP exam?
Yes
No
Score:
List other High Schools you have attended:
School Name:
School Name:
City:
City:
State:
State:
Zip:
Zip:
Dates Attended:
Reason for Leaving:
Dates Attended:
Reason for Leaving:
College Information - Please list all colleges at which you have taken courses for credit.
Request an official transcript from each institution as soon as possible.
College:
City:
State:
Zip:
Dates Attended:
Degree Earned:
College:
City:
State:
Zip:
Dates Attended:
Degree Earned:
College:
City:
State:
Zip:
Dates Attended:
Degree Earned:
Have you ever been dismissed or suspended from high school and/or college?
Yes
No
If yes, please explain:
Have you previously applied for admission to Iowa Wesleyan College?
Yes
No
If yes, what year?
_____________________________________________________________________________________________
ACTIVITIES AND HONORS - Please check activities in which you been involved in grades 9-12.
This information may be shared with organizations and coaches.
Dance
Choral
Newspaper
Visual Arts
Honor Society
Drama
Yearbook
Student Government
Other:
Please list any sports you are considering participating in at Iowa Wesleyan College (varsity level only).
Please list any additional activities and honors
Volunteer work/community service/religious activities.
Work experience (give position,dates,hours per week)
_____________________________________________________________________________________________
FAMILY INFORMATION
Father's name in full (indicate if deceased):
Home Address:
City:
State:
Zip:
Occupation:
Employer:
Work Phone:
Email:
Colleges Attended:
Mother's name in full (indicate if deceased):
Home Address:
City:
State:
Zip:
Occupation:
Employer:
Work Phone:
Email:
Colleges Attended:
Are your parents divorced/separated?
Yes
No
If so, with whom do you reside?
Mother
Father
Guardian
List the name(s) of your sibling(s) (include name, age, relationship,year in school,school or college name)
List the name(s) and relationship of relatives who attended Iowa Wesleyan College:
Have you ever been charged with a violation of the law which resulted in probation, a jail sentence or
the revocation or suspension of your driver's license?
Yes
No
If yes, explain:
*
*
*
*
*
*
*
*
*
*
*
Yes
No
If yes, date taken:
High School City:
(Use Code 001871)
May we have your permission to send admission/scholarship/involvement information to local media?
Yes. Local Newspaper:
No
Education Students-Check which, if any, endorsements is of interest to you: (Hold CTRL to select multiple)
