Application Form | Indiana Wesleyan University - LEAP Program

Application Form

Please complete all required section below. You will need to expand each section to see all related questions.

Personal Information

Full Name: *

Please enter your full name: first, middle and last name

Other Names:

Names that may appear on transcripts/documents

Mailing Street Address: *

Mailing City, State & Zip Code: *

Email Address: *

Home Phone Number: *

Work Phone Number:

Page/Cell Phone Number: *

Fax Number:

Birth Date:

Birth Place:

Country of Citizenship: *

Educational Background

Please indicate whether you are a High School Graduate or have obtained your GED: *

High School Graduate

GED

-Name of High School:

If you are a high school graduate, please enter the name of the high school you graduated from. Otherwise, please leave blank.

Have you taken classes through IWU or Marion College before?: *

Yes

No

-If you have attended IWU/Marion College, enter your date of attendance.:

Undergraduate Study: List all post secondary institutions attended and degrees earned. An official transcript is required from every post secondary institution you have ever attended.

Please click on the sections below to fill out the pertinent information.

Undergraduate Study #1

#1 Institution Name:

#1 Institution Location:

#1 Date(s) of Attendance:

#1 Degree Earned:

#1 Credit Hours Earned:

Undergraduate Study #2

#2 Institution Name:

#2 Institution Location:

#2 Date(s) of Attendance:

#2 Degree Earned:

#2 Credit Hours Earned:

Undergraduate Study #3

#3 Institution Name:

#3 Institution Location:

#3 Date(s) of Attendance:

#3 Degree Earned:

#3 Credit Hours Earned:

Employment History

At least one employment reference is required. You must indicate at least two years of previous work experience to be considered for admission.

Please click on the sections below to fill out the pertinent information.

Current Employment

Employer Name:

Employer Address:

Current Position:

Type:

Start Date:

Please enter Month and Year (i.e. 01/2010 or January 2010)

Previous Employment #1

#1 Employer Name:

#1 Employer Address:

#1 Your Position/Title:

#1 Employment Type:

#1 Start Date:

Please enter Month and Year (i.e. 01/2010 or January 2010)

#1 End Date:

Please enter Month and Year (i.e. 01/2010 or January 2010)

Previous Employment #2

#2 Employer Name:

#2 Employer Address:

#2 Your Position/Title:

#2 Employment Type:

#2 Start Date:

Please enter Month and Year (i.e. 01/2010 or January 2010)

#2 End Date:

Please enter Month and Year (i.e. 01/2010 or January 2010)

Previous Employment #3

#3 Employer Name:

#3 Employer Address:

#3 Your Position/Title:

#3 Employment Type:

#3 Start Date:

#3 End Date:

Please enter Month and Year (i.e. 01/2010 or January 2010)

Financial Aid

Are you interested in applying for Financial Aid?: *

Yes

No

Are you interested in applying for Veterans Benefits?: *

Yes

No

Will your employer reimburse you for tuition?: *

Yes

No

-If your employer will reimburse for tuition, what percentage or total amount? (Maximum allowable per year): :

Application Fee

A $25.00 non-refundable application fee is required to process your application. Your method of payment?: *

Credit Card (Please call 877.687.3468, ext. 3269 to submit).

Check/Money Order (Please mail to: 1900 W. 50th St., Marion, IN 46953

Paid with previous application

*** This fee is not required if you have already paid an application fee with a previous IWU application. If so, please select "Paid with previous application" from the list above. ***

Application Submission

I understand that I am responsible for the submission and receipt of official transcripts of my records, and that the University will accept for its permanent file, only those transcripts issued directly by the Registrar of each institution I have attended. Formal admission to Indiana Wesleyan University as a degree candidate is granted only after all admission materials have been received and all minimum standards are met.

I certify that the statements in this application are correct to the best of my knowledge. I further authorize Indiana Wesleyan University to make appropriate inquiries when necessary to certify the accuracy of my records. I understand that failure to answer any questions on this form truthfully and accurately might make me ineligible for admission to Indiana Wesleyan University or may result in my dismissal from the University.

If you encounter any problems submitting this form or do not receive an immediate confirmation, please call Staci Jefferies at 877-687-3468, ext. 3269 to check the status of your application.