Online Application for Admission

First Name:*
Last Name:*
Middle Name or Initial:
Maiden Name: (if applicable)
Preferred Name:

Street Address:*
City:*
State:*
Zip:*
Phone:*
Phone:
E-mail:*
Confirm E-mail:*

Permanent Mailing Address: (if different from above)
City:
State:
Zip:

Birth Date:
Name of Legal Guardians: (if a dependant)

Personal Information	(optional–answering this section will not increase or decrease your chances for admission)
Gender:	Male Female
Race/Ethnicity:
Marital Status:	Single Married
Spouse's Name: (if applicable)

Would you like to apply for the Merit Scholarship? (On-campus applicants only. See website for details.)	Yes No
Would you like to be contacted about financial aid opportunities? (more info)	Yes No
Do you or your parents\guardians qualify for the G.I. Bill? (more info)	Yes No

Please list the colleges and/or universities previously attended (including GWU, if applicable) beginning with the most recent. Undergraduate applicants should also list institutions of secondary education.
A.	School Name:
	Location:
	Major:
	Dates Attended:
	Degree:

B.	School Name:
	Location:
	Major:
	Dates Attended:
	Degree:

C.	School Name:
	Location:
	Major:
	Dates Attended:
	Degree:

Application Fee:
Card Type:
Card Number:
Expiration Date:
Name on Card:
Billing Address:	Same as Mailing Address

I certify that all materials provided as part of the admissions process (excluding letters of recommendation) are my own work and are complete and accurate to the best of my knowledge. I understand and agree that any misrepresentation or omission of facts in my application may result in a rejection of this application for admission.

I authorize George Wythe University to collect the appropriate application fee using the charge\credit card information I have provided, including a $25 late fee if I am applying after the posted application deadline. I understand that these fees are non-refundable and non-transferable.


	* Required Fields

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