Enroll at the Adult & Graduate Level

Student Demographic Information

First Name*

Preferred First Name

Middle Name

Last Name*

Other Last Name Used

Birthdate*

Why do we collect Date of Birth?

Marital Status

Religious Affiliation

Legal Sex

Why do we collect Legal Sex?

Felony Conviction *

Yes

Student Contact Information

Email Address*

Mailing Address*

Country

Street

City

Region

Postal Code

Mobile Phone Number *

Mobile Opt In

Yes

I authorize text messages to the mobile telephone number above and accept responsibility for any charges incurred.

Citizenship Information

Primary Citizenship *

Dual Citizenship

Permanent Resident of the United States*

Please note that if you are not a US Citizen, the TOEFL may be required.

Type of Visa

Visa Expiration Date

A Social Security Number is not required for the completion of your application. However, it is required for the distribution of financial aid. If you intend to apply for financial aid, please provide your SSN in the space provided below. Thank you for your help in ensuring a smooth admissions process!

Social Security Number

Privacy Protection Policy

Will you be filing the FAFSA?

Yes

Student Academic Information

Student Type *

Enrollment Plan

Application Type *

Academic Interest *

Cohort Location *

PTT Entry Term (Cohort specific)

Academic Focus for Initial Certification *

Academic Focus for Pathway to Teaching *

Intended Entry Term (Re-Enroll) *

Intended Entry Term (Non-degree) *

In a brief paragraph, please share your reason for leaving Roberts Wesleyan University and explain why you feel you are ready to return. *

Please list any activities you participated in since attending Roberts Wesleyan University (employment, attended another college, volunteerism, etc.)*

Delete_ID_
Please list all colleges/universities that you have attended, including Roberts Wesleyan University.
If you are intending to Re-Enroll at Roberts, please indicate any schools you have attended since you last attended Roberts. If you have not attended any other institution, please enter "Roberts Wesleyan University" and the approximate start and end date of your last attendance in the form below. College/University Name College/University CEEB Level of Study Start Date Start Date End Date End Date

Click here to add a college/university.

Terms of Agreement

By signing and dating this form, I affirm that I am the individual identified in this application and that all information included is accurate to the best of my knowledge.

Electronic Signature *

Today's Date *