1
Undergraduate Application
Last name First name Middle name Previous name(s)
Address City State Zip
Parent/Spouse (circle one) Last name First name Middle initial
Parent/Spouse Address City State Zip
Home telephone number Business number Cell number...
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1
Undergraduate Application
Last name First name Middle name Previous name(s)
Address City State Zip
Parent/Spouse (circle one) Last name First name Middle initial
Parent/Spouse Address City State Zip
Home telephone number Business number Cell number
Gender: (check one) Male Female Birthdate: Social Security number:
Citizenship: U.
S.
Citizen Permanent Resident (provide copy of form I-551) Nonresident Alien (request international application)
(Wright State is required by the federal government to report this information, however, reporting it on this form is strictly voluntary for students.
)
Ethnicity: Are you Hispanic or Latino? Yes No
Race (select all that apply) Black or African American American Indian/Alaskan Native Asian Native Hawaiian/Other Pacific Islander White
E-mail address
High school attended City State ACT high school code Graduation date
College/university attended City State First and last dates attended Degree(s) earned
College/university attended
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