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Full Legal Name

First Name

Middle Name

Last Name

Previous Legal Last Name(s)

Suffix

Preferred or Nickname

Phone and Email Information

Cell Phone (Include area code)

Home Phone (Include area code)

Home Phone refers to a land line. If you do not have a land line please leave this field blank.

Email Address

Confirm Email Address

Address Information

Address (This is where ALL school-related mail will be sent.)

City

State

ZIP Code

Demographic Information

We are asking for your help in responding to a variety of requests from federal and state agencies for data describing our students and staff. Because we want to ensure all our students have the best opportunity to succeed at Washburn Tech, this data may also be used internally at Washburn to identify resources for you individually that are available and have assisted others in achieving success as a student at Washburn Tech. Reporting this information is voluntary and it will be treated as confidential information.

Birth Date (MM/DD/YYYY)

Gender

Have you previously attended Washburn Tech or other colleges, universities, or technical schools?YesNo

Academic Plans

Choose your program of interest.

Choose your anticipated entry term.

Choose your course level.

Session Preference

Academic History

Will you be attending Washburn Tech while still in high school?YesNo

Have you attended any other colleges, universities, or technical schools?YesNo

Campus Plans

Are you interested in on-campus housing?

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