Homebase Application Form

Please complete all requested information before submitting this form. Walla Walla University is required to gather data on students who apply or enroll. Though supplying some of this information is optional, we would greatly appreciate receiving it. If you wish to submit your application by mail or FAX, you may complete and print this form and send it to: Enrollment Walla Walla University 204 South College Avenue College Place, WA 99324 FAX (509) 527-2397
Personal Information
* Full Legal Name:
Former or Maiden Name:
Preferred Name or Nickname:
* Preferred Phone Number:
Other Phone Number:
Work Phone Number:
* E-mail Address:
Social Security Number (Optional):
Permanent Address
* Address Line 1:
Address Line 2:
* Name of City or Town:
* State or Province (US and Canada Only):
* Country:
* ZIP Code or Postal Code:
Do you have a seasonal address?
Seasonal Address
* Is this a summer address or a school year address?
Other:
* Address * City * Zip/Postal Code
* Country
What are the dates that this address will be valid?
Parent or Spouse Information
Check one:
Attended WWU?
Name:
Address:
City, State, ZIP:
Preferred Telephone:
E-mail Address:
Check one:
Attended WWU?
Name:
Address:
City, State, ZIP:
Preferred Telephone:
E-mail Address:
Application Information:
If applying for re-admission, what is your WWU ID #?
* Which quarter do you plan to enter the Homebase program?
Year:
* Major/Area of study:
Educational Experience
* Have you ever been on academic probation, suspended, or dismissed?
* Explain:

* Name of high school you graduated from or expect to:
* City, State:
* Year of high school graduation:
Previous Colleges/Universities
* Have you had previous college experience?
List below all schools attended or entered since high school. If still enrolled, indicate intended leaving date. Start with the most recent attended school.
Name of College/University:
City, State:
Started Attendance:
Ended attendance:
Degrees acquired (List none if applicable):
Name of College/University:
City, State:
Started Attendance:
Ended attendance:
Degrees acquired (List none if applicable):
Name of College/University:
City, State:
Started Attendance:
Ended attendance:
Degrees acquired (List none if applicable):
Statistical Information
Equal Opportunity Commitment. Walla Walla University maintains a policy of equal educational opportunity for all applicants without regard to gender, race, color, national and/or ethnic origin, age or physical handicaps, and in administration of its educational and admissions policies, financial aid, employment programs, student life and services, or any other college-administered programs.
* Date of Birth:
Marital Status:
Gender:
What is the name of the church that you normally attend?
Are you of Hispanic/Latino origin?
If yes:
* Other Hispanic origin:
Are you one or more of the following?
Other Asian:
Other Black:
Other Pacific Islander:
Other Ethnicity:
* State or Country of Home Residence:
* Country of Birth:
* Citizenship:
* Country of Citizenship:
* Type of Visa:
* Visa Type:
* Visa Number:
* Date Visa Issued:
* Date Visa Expires:
Religious Preference (Optional):
* Have you ever been convicted of a criminal offense?
*
* Provide dates and charges of all criminal convictions:

Send a copy of all criminal complaints specifying the allegations or the indictment. Nondisclosure may act to invalidate application/enrollment. Application information is considered on an individual basis and you may attach an explanation.
Statement of Agreement
Walla Walla University welcomes persons from all backgrounds who respect a Christian way of life and apply mature judgment to their academic, spiritual, and social lives. Walla Walla University is committed to quality Christian education and is affiliated with the Seventh-day Adventist Church. Students, faculty, and staff share in the mutual obligation to uphold the Christian philosophy and policies of the university. A description of student life on our campus can be found online.
* By initialing this form, you acknowledge use of your electronic signature as shown and that all the information submitted on this form is truthful, complete and correct to the best of your knowledge:
Timestamp
Thu Apr 24, 2014 11:25 pm
Application Fee
Application Fee:
40.00
Please select a payment method

* Online Payment Options:      
US or International payment
Please send checks to:
Office of Enrollment
Walla Walla University
204 S. College Avenue
College Place, WA 99324-1198
Please call (800) 541-8900
After clicking the "Submit" button below, you will be asked for your credit card information.
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