WSU - LEAP Online Application

LEAP Admission Application

Last Name:
First Name:
Middle:
Current Mailing Address:
Phone Number:
Email:
Birthdate:
Sex:	Male Female
Married:	Yes No
Country of citizenship:
City & Country of Birth:
	Are you in the U.S.? If yes, indicate what type of visa you have :
Date of first entry to the U.S. (MM/DD/YYYY):
Are you outside the U.S.? If yes, indicate the visa you intend to enter the country with: F-1 J-1 Other
Nearest Relative in the United States (if any):	Parent Spouse
Enter full name:
Relative's Address:
Relative's 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:

Are you planning to apply for conditional admission to a Wright State University program after LEAP?
If yes, apply now for conditional admission: UNDERGRADUATE: Undergraduate Admissions Checklist GRADUATE: Graduate Admissions Checklist Questions about conditional admission? Email claudia.espinoza@wright.edu
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 or 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: