Student Information Form - Wayne State University

Fields with asterisks (*) are required.

Program Name *

First Name *

Last Name *

Full Legal Name (as on passport) *

Date of Birth (MM/DD/YYYY) *

Gender *

Male

Female

Email *

**Most correspondence from our office will be via e-mail. Please list one you check regularly.**

Address line 1 *

Address line 2

City *

State/province/region *

Postal/zip code *

Country *

Phone Number *

Alternative Phone Number *

Country of Citizenship *

**Please note: If you are not a US Citizen, it is your responsibility to obtain a visa to enter the country you will be visiting. Not all programs require a visa so check online or with an adviser if you are uncertain.

Are you currently enrolled in a WSU degree program? *

Yes

If yes, what is your major?

Are you an international WSU student? *

Yes

Current GPA *

Are you in the Honors Program? *

Yes

Are you a DCE Student? *

Yes

Race/Ethnicity (Please note that this is for statistical purposes only; does not affect program eligibility. If you are multi-racial, please choose the one you identify with most.) *

Emergency Contact

Name *

Relationship to You *

Phone Number *

Address *

City *

State *

Zip Code *

Alternate Phone Number