Application for Admission

Personal Information

First Name:

Middle Name:

Last Name:

Email:

Phone:

Type of phone:
Home Work Cell
Can we text you?

Zip:

Address:

Apt./#:

City:

State:

Gender:
Male Female

Birth date:

Birthplace City:

Birthplace County:

Birthplace State:

Citizenship:
US Citizen
US Permanent Resident
Non-Resident Alien
Other:

Country of Citizenship (if not US citizen):

If you are a non-resident alien, please indicate the non-resident visa status you currently hold:
I require a student visa     I require a change of status
(clear visa fields)

I am requesting transfer to your campus from:

What race do you consider yourself to be?:*
African American/Black
Alaskan Native or American Indian
Asian
Filipino
Hispanic/Latino(a)
Native Hawaiian or Other Pacific Islander
White
Other/No response

Are you a veteran?:
Yes No

Will you be using VA Benefits, Yellow Ribbon or applying for Veteran's assistance to help cover your tuition?:
Yes No

 

Admission Information

Program:

Campus:

How did you hear about us:

 

Emergency Contact

Full name of contact:

Address:

Phone:

Relationship:

 

Certification & Disclosure

Statement of Disclosure: Have you ever been charged with or convicted of any felony or misdemeanor (other than minor traffic violations) including juvenile charges, drug and alcohol offenses, deferred prosecutions/judgments, and expunged convictions?:
Yes No

I certify that all information contained in this application is factually correct and complete. I understand that the omission or misrepresentation of any information, including enrollment in other colleges or universities, may void my admission or result in dismissal. *

 

eSign Application

First and Last Name required
Signature
Date

 

By clicking above, I consent to be contacted by a university representative with information for educational opportunities at the number(s) provided above. I understand calls may be initiated by an automated telephone dialing system. I need not grant this consent to receive information or to be eligible to enroll with WCU. I understand if I do not wish to consent, I may call 866-508-2684 for more information.

Security and Fire Safety Information - Annual Security Report: West Coast University is committed to partnering with students, faculty and associates to create a safe campus community. Information regarding campus security as well as personal and fire safety, that covers topics such as Campus Security Authorities; disciplinary procedures; and crime prevention, reporting, and statistics for the most recent three-year period, is available at westcoastuniversity.edu/safety-security.html. You may also request a paper copy of the report by sending your request to safetyandsecurity@westcoastuniversity.edu.

Note: calls may be recorded for quality assurance purposes.

* Required Fields