Intensive English Online Application Form

APPLICANT INFORMATION

Last Name/Family Name*

First Name/Given Name*

Middle Name

Birthdate*

Gender

Email Address*

Phone Number*

Parent Email Address:

Student's Secondary Email Address*

Mailing Address*

Country

Street

City

Region

Postal Code

Permanent Address*

Country

Street

City

Region

Postal Code

Country of Citizenship*

Country of Birth*

City of Birth*

VISA INFORMATION

Are you currently in the US?*

Yes

What type of visa?

If you are currently in the U.S., please visit www.wichita.edu/applyinternational and apply with our regular application for admission. The online Intensive English Program is only for students outside the U.S.

TERM INFORMATION

Desired Term*

Major*

How did you hear about WSU?*

AGENT INFORMATION

Are you working with an agent?*

Yes

Name of Agency

Name of Agent

Agent's Email Address

EDUCATION HISTORY

Please list all schools you have attended (secondary and post-secondary)*

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School Name* Date Attended From Date Attended From Date Attended To Date Attended To

Add a School