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2004-2005
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Supplement to 2002-2004
Graduate Catalog
Application for Admission
to a Graduate Status
| September(fall)20__ January(winter)20__ March(spring)20__ June(summer)20__ |
Indicate month and year you wish to enroll if admitted |
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PERSONAL INFORMATION |
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Yes No |
Social Security Number |
Have you previously applied for graduate admission at Wright State University? |
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| Legal or Family Name | First | Middle | Previous name(s), if any |
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| Street address | City | State | Zip |
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| Area Code/Phone | E-mail address |
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| Business telephone number | Birthday/Month, day, year | Sex: Female Male |
| (This information is required
by the federal government; however, reporting it on this form is
strictly voluntary.) White Non-Hispanic Black Asian or Pacific Islander Hispanic American Indian or Alaskan Native International |
|
Yes
No On active military duty in Ohio or a dependent of such person |
Yes
No Employed full time in Ohio |
Yes
No Employed part time in Ohio |
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RESIDENCY INFORMATION |
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Country of citizenship _______________________ City and country of birth
______________________ State of residency ____________ If Ohio resident indicate county of permanent residence __________ Dates you have lived in Ohio: ___ Never; ___ From birth to present; ___ From month ___ year ___ to month ___ year ___ Are you a resident alien? _____ If yes, provide copy of Form I-151. Are you a non-resident alien? _____ If yes, indicate visa and date of entry into the United States _______________________ |
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ACADEMIC INFORMATION |
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1. Admission Status (I am applying for the following status): Degree Nondegree Transient Licensure (school personnel seeking additional licensure and others as noted on Instruction Sheet Insert) 2. Desired degree M.A. M.Acc. M.S. M.S.C.E. M.S.Egr. M.Ed. M.B.A. M.H. M.R.C. M.S.T. M.M. M.P.A. Ed.S. Ph.D. |
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3. ____________________________________ Selected Program (see programs list) |
4. ____________________________________ Major/Concentration (see programs list) |
| 5. Do you intend to pursue your program of study on a : Full-time basis Part-time basis |
| Do not write below ths line | Academic information continued on next page |
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School of Graduate Studies
E344 Student Union
Voice: (937) 775-2976
Fax: (937) 775-2453
E-mail: wsugrad@wright.edu
E344 Student Union
Voice: (937) 775-2976
Fax: (937) 775-2453
E-mail: wsugrad@wright.edu
