Legal name
Last		First	Mid
Nickname		Former last name(s) if any

Birth date (mm/dd/yyyy)

Gender Male Female

E-mail

Current mailing address
PO Box/Street	City or Town	State/Province	Zip/Postal Code
Permanent home address
PO Box/Street	City or Town	State/Province	Zip/Postal Code
Current phone number	Cell phone number

Religious affiliation
Are you a member of the United Methodist Church? Yes    No
Name of church	Name of pastor

Educational Data

High School Attended

City

State

Date of Graduation (mm/dd/yyyy)

Name of high school counselor

School phone

If you received a GED, list date

Test Information
Indicate scores and dates you have taken (or plan to take) either of the following tests:

ACT		SAT
Composite score/Date taken		Verbal/Math/Writing/Date taken

 

Enrollment Data

Are you seeking a degree?    Yes - BA     Yes - AA     Not at this time

Major Please Select >> Accounting Art Athletic Training Behavioral Science Biochemistry Biology Business Business/Finance Business/Management Business/Marketing Church Music Communication Criminal Justice Education Elementary Education English General Studies History Human Services Mathematics Multimedia Music Nursing/RN - 2yr, Mitchell Campus Nursing/RN - 2yr, Huron Campus Nursing/RN - 4yr, Mitchell Campus Nursing/LPN to RN - Sioux Falls Campus Physical Education Pre-dental Pre-law Pre-medicine Pre-optometry Pre-physical Therapy Pre-veterinary Science Psychology Public Service and Leadership Religion and Philosophy Special Education Sport, Exercise and Wellness Sports Management Theatre Undeclared Wildlife Management

Minor Please Select >> Undecided Art Behavioral Sciences Biochemistry Biology Business Chemistry Coaching Communication Computers and Technology Criminal Justice Cultural Studies Desktop Publishing English Entrepreneurial Leadership Fine Arts Forensic Accounting German History Human Services Language Legal Studies Mathematics Multimedia Music Political Science Psychology Public Service and Leadership Religion and Philosophy Sociology Spanish Theatre

If seeking a nursing major, are you a LPN or RN? Select >> LPN RN

Housing request:   Please Select >> On campus Parent's home Own residence Other

University policy requires that full-time, unmarried students under the age of 21 reside on campus.
This policy does not apply to students living with their parents within a 40 mile radius
of campus, or students with dependent children.

Family

Please list the adults who are legally responsible for you and/or have rights to your information.
If a minor, this is usually one or both biological parents when living.
  

Parent/Guardian 1
First name
Last name
Mid
Parent/Guardian 1	Mother Father Legal Guardian Unknown
Is Parent/Guardian 1 living?	Yes    No
Home address if different from yours
Home phone
E-mail
Occupation
Name of employer
College (if any)
Degree
Year

Parent/Guardian 2
First name
Last name
Mid
Parent/Guardian 2	Mother Father Legal Guardian Unknown
Is Parent/Guardian 2 living?	Yes    No
Home address if different from yours
Home phone
E-mail
Occupation
Name of employer
College (if any)
Degree
Year

Parents’ Marital Status (relative to each other):	Never married Married Widowed Separated Divorced
With whom do you make your permanent home?	Parent/Guardian 1 Parent/Guardian 2 Both Other

Please give names and ages of your brothers or sisters.
If they have attended college, give the names of the institution and degree earned.

More about you
 

List activities you might like to participate in while a student at Wesleyan.
How did you learn about Dakota Wesleyan University?
To what other colleges or universities are you considering for your education?
Wesleyan is my:	Please Select >> 1st choice 2nd choice 3rd choice
What factors will be most important in your college decision?

Describe any special circumstances and/or concerns which you believe should be considered
in connection with your application for admission.

Have you ever been found responsible for a disciplinary violation at any secondary or post-secondary school you have attended, whether related to academic misconduct or behavioral misconduct, that resulted in your probation, suspension, removal, dismissal, or expulsion from the institution?
Yes    No

Have you ever been convicted of a misdemeanor, felony, or other crime?
Yes    No

If you answered yes to either or both questions, please explain and give approximate
date of each incident and explain the circumstances.

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I certify that all information in my application is my own work, factually true, and honestly presented. I understand the omission or misrepresentation of any information including enrollment in other colleges or universities is sufficient grounds for canceling my admission or registration. Yes

The university reserves the right to deny admission or continued enrollment to any student who imposes an unreasonable risk of harm to the health, safety, welfare or property of the university, members of the university community or him/herself.

Dakota Wesleyan University is accredited by the Higher Learning Commission of the North Central Association, 30 North LaSalle Street, Suite 2400, Chicago, IL 60602, (312)263-0456, www.ncahlc.org, South Dakota Department of Education, South Dakota Board of Nursing, National League for Nursing, United Methodist University Senate, and Commission on Accreditation of Athletic Training Education. The university is approved by the state of South Dakota on the basis of the National Association of State Directors of Teacher Education Certification (NASDTEC) standards.