WSU SOM Student Registration Information

Fields with asterisks (*) are required.

First name *

Last name *

Email *

Class Of *

WSU Banner ID: (9 Digit number starting with 000) *

Phone Number *

Address 1 *

Address 2

State *

City *

Zip *

Emergency Contacts (Please provide at least one contact)

Contact 1 Name *

Contact 1 Relationship *

Contact 1 Primary Phone *

Contact 1 Secondary Phone

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Contact 2 Name

Contact 2 Relationship

Contact 2 Secondary Phone

Contact 2 Primary Phone