Shocker-Academy FA24

Shocker Academy Fall 2024 Application
For juniors & seniors who are highly motivated with strong time management & organizational skills looking for an affordable introduction to higher education, Shocker Academy offers the perfect opportunity. Students will be put on a path to complete more than 30 general education courses, like English, College Algebra and others, all before graduating high school.

An opportunity provided by:

Biographical Information

First Name

Middle Name

Last Name

Alternate Last Name

Birthdate

Cell Phone

Email Address

Sex Assigned at Birth

Social Security Number (optional, but strongly recommended)

Mailing Address

Country

Street

City

Region

Postal Code

Country of Birth

Are you a U.S. citizen?

Yes

No

Primary Citizenship

What citizenship or visa status do you currently hold?

Ethnicity (Optional)

If you wish to be identified with a particular ethnic group, please select the choice that most accurately describes your heritage. No information you provide will be used in a discriminatory manner.

Are you Hispanic or Latino?

Please select one or more of the following races:

Kansas Residency

Are you a resident of the state of Kansas?

Yes

No

Have you lived in Kansas since birth?

Yes

No

When did you start living continuously in Kansas

If you relocated to Kansas, from which state/province did you move?

Have you previously lived in Kansas?

Yes

No

Start Date:

End Date

Last year, did anyone claim you as a dependent for income tax purposes?

Yes

No

Is either of your parents or your guardian a Kansas resident?

Yes

No

How long has he or she been a Kansas resident?

Years

Months

High School Information

High School Attending

Grade Level

High School Graduation Year

What PM session course(s) would like to be enrolled in:

English 1 (12:30-1:20pm) MWF

Sociology 1 (12:30-1:45pm) TR

Art Appreciation (1:30-2:20pm) MWF

Philisophy (2:30-3:20pm) MWF

Accounting (2:00-3:15pm) (ACCT160 1st 8weeks/ ACCT170 2nd 8weeks) TR

1st year Seminar (2:00-3:15pm) TR

Spanish 1 (3:30-4:55pm) MWF

Parent/Guardian Information

Parent/guardian permission is required for a high school student to take high school guest classes at WSU. Does the parent/guardian of the above listed student consent to that student’s high school guest?

Yes

No

What is the highest level of education that your mother completed?

What is the highest level of education that your father completed?

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Parent/Guardian Phone Number

You can give others (parents, employers, etc.) the ability to access your account information. In compliance with the Family Educational Rights and Privacy Act of 1974 (FERPA), your student financial records may not be shared with a third party without your written consent. Adding an authorized user is your written consent that an individual may view your account information and make payments on your behalf. Please note that authorized users DO NOT have access to your stored payment methods, academic records, or other personal information.

Would you like to authorize your parent/guardian as an authorized user to view/pay your bill for your high school guest course at Wichita State?

Yes

No

Email Address of Authorized User

Notice of Participation

By signing this application, I am indicating my intention to participate in the Wichita State University (WSU) and WSU Campus of Applied Sciences and Technology (WSU Tech) Shocker Academy (the “Program”). I understand and agree that:

this Intent to Participate form does not include any program or major;

the information given on this application is complete and accurate, to the best of my knowledge;

any failure to disclose fully and accurately all facts relating to this application shall be grounds for disciplinary action, up to and including suspension or expulsion from the Program;

I am subject to the same admission, matriculation, disciplinary and degree requirements governing all other WSU and WSU Tech students;

I agree to abide by all policies and procedures of WSU, WSU Tech, and the Program; and

I agree to be responsible for payment of all tuition, fees, books, supplies due to WSU and/or WSU Tech for my enrollment in the Program.

It is the policy of WSU and WSU Tech to maintain the confidentiality of academic records and to be in compliance with all federal and state laws, including but not limited the Family Educational Rights and Privacy Act (FERPA), governing the release of academic records. In accordance with these laws, neither WSU nor WSU Tech will permit access to, nor the release of, personally identifiable information contained in academic records to any party without the written consent of the student, unless otherwise allowed by law. Pursuant to 20 USC 1232g(b)(1)(B), an educational institution may disclose an education record of a student in attendance to another educational agency or institution if the student is enrolled in or receives services from the other agency or institution and the disclosing institution has met all disclosure requirements. Accordingly, by signing this form:

I authorize WSU to release to and share with WSU Tech all my admission, financial, academic, and advising information; and

I authorize WSU Tech to release to and share with WSU all my admission, financial, academic, and advising information.

WSU and WSU Tech admit students of any race, color, national origin, age, gender, disability, or sexual orientation to all rights, privileges, programs, and activities generally accorded or made available to students at these institutions.

This is an official publication. It is subject to change at any time, without notice. WSU and WSU Tech reserve the right to add, withdraw, or revise any course, program of study, provision, or requirement described herein, in its/their sole discretion.

I have read and understand the conditions set forth herein and agree to be bound by these conditions.

Signature