Wright State University | College of Liberal Arts | LEAP Make a Gift

LEAP Admission Application

Indicate the semester and year you wish to enroll, if admitted:
Indicate how long you wish to be in the LEAP program:

Personal Information Last Name:
First Name:
Middle Name:

Current Address Address:
City:
State/Province/Region:
Zip/Postal Code:
Country:

International Address Address:
City:
State/Province/Region:
Zip/Postal Code:
Country:

Phone Number:
Email:
Birthdate (MM/DD/YYYY):
Sex: Male Female
Married: Yes No
Country of Citizenship:
City of Birth:
Country of Birth:
Are you in the United States? Yes No

If yes, indicate what type of visa you have:
Date of first entry to the United States (MM/DD/YYYY):

If no, indicate the visa you intend to enter the country with:
F1 J1 Other:

Nearest relative in the United States (if any) Full Name:
Address:
City:
State:
Zip Code:
Phone Number:

Academic Information Have you previously applied for LEAP? Yes No
Will you apply for campus housing? Yes No
High School:
City:
Country:
Graduation Date:

If you have dependents coming with you on F2 visas, please send their names and relationship to you:

The information given above is complete and accurate to the best of my knowledge. I understand that misrepresentation of facts on this application will be cause for refusal of admission, cancellation of admission, or dismissal from the university. The university also reserves the right to revoke any degree or diploma that it may have awarded in reliance on information contained in the application for admission and it subsequently transpires that this information was a fraudulent misrepresentation of fact.
By signing this application, I agree to abide by the policies and regulations of the university.
Type your name here: Date:

Last updated: March 8, 2013

133 Allyn Hall
Wright State University
3640 Colonel Glenn Hwy.
Dayton, OH 45435-0001
(937) 775-5287
leapadmissions@wright.edu

Join us on Facebook!

LEAP

Learning English for Academic and Professional Purposes

LEAP Admission Application