Please Type Or Print Clearly in Ink. No Application Fee Is Required

AT CINCINNATI STATE

www.wilmington.edu

Application for Admission

Please type or print clearly in ink. No application fee is required.

PERSONAL DATA
Name
Last / First / Middle
Maiden Name
Address
Street
City / State / Zip / Country / County
E-mail / Birth Date
mm/dd/yyyy
Telephone / ( ) / ( )
Home / Cell
Social Security Number / - - / State of Legal Residence / U.S. Citizen? / Yes No
Employer / Telephone / ( )
Company Name / Position / Work
OPTIONAL INFORMATION / wilmington college uses this information for statistical purposes only.
Gender: / Male Female / Marital Status: / Single Married Divorced Widowed
Are you Hispanic/Latino? / Yes No
How would you describe yourself?
American Indian or Alaska Native / Asian / Black or African American
Native Hawaiian or other Pacific Islander / Non-Resident Alien / Two or More Races / White
Religious Affiliation
If Quaker, are you an active member of a yearly meeting? / Yes No
If Quaker, are you or your parent/spouse a pastor of a monthly meeting? / Yes No
ENROLLMENT INFORMATION
Applying for Semester beginning 20 / (check one) / Fall Spring Summer
Applying as a :(check one) / First-time college student Transfer student
Have you previously applied to Wilmington College? / Yes No / If yes, please state year applied:
ACADEMIC INTERESTS
Primary academic major interest:
Business Administration – Management Concentration
Business Administration – Business Analysis Concentration
Multimedia Studies
Double Major: Business Administration – Management Concentration and Accounting*
*This double major is only available to Cincinnati State graduates who have completed an associate's degree in Accounting Technology at Cincinnati State Technical and Community College.
EDUCATIONAL DATA
List all high schools attended, beginning with the most recent.
Name of High School / Location / Dates of Attendance
(month and year) / Date of Graduation
(month and year)
List all colleges, universities or post-secondary institutions attended, including non-U.S. institutions, beginning with the most recent.
Name and Location of Institution* / Dates of Attendance
(month and year) / Degree Earned / Reason for Withdrawal / G.P.A.
AssociatesCertificateBachelorsMasters
AssociatesCertificateBachelorsMasters
AssociatesCertificateBachelorsMasters
*An official college transcript from each institution is required to complete your admission file.
ADDITIONAL INFORMATION
To what other colleges or universities are you applying this year?
How did you hear about Wilmington College Blue Ash Campus?
Are you applying for financial aid at Wilmington College? / Yes No
Are you eligible to receive benefits through any of the Veterans Administration Programs? / Yes No
Are you eligible for tuition benefits from Wilmington College or your employer? / Yes No
Have you ever been convicted of a felony or are any currently pending? / Yes No
We will contact you on a regular basis regarding admission and financial aid matters. Please check below the method(s) in which you prefer to be contacted.
Home Telephone Cell Phone Work Telephone E-mail Address
Check here if you are open to being contacted by WC via text messaging. (Standard messaging charges may apply.)
SIGNATURE OF APPLICANT / required
I certify that the information on this form is true and that any purposeful misrepresentation may result in denial of admission or dismissal from Wilmington College.
Signature (Required) / Date
If you would like to note any factors not previously mentioned that would support your Application for Admission, please attach an additional sheet.
Submit application to the following address:
WILMINGTON COLLEGE at CINCINNATI STATE
3520 Central Parkway, Room 330 BTD • Cincinnati, OH 45223
PHONE (513) 569-1806 • FAX (513) 569-1467

For more information, go to www.wilmington.edu/cincinnati
Wilmington College does not discriminate on the basis of age, race, color, religion, national or ethnic origin, gender, sexual orientation, or disability in the administration of education policies, admission policies, financial aid, employment or any other college program or activity. Also, in compliance with federal law, the College has prepared annual Campus Safety and Security reports. These reports include a description of the following: Wilmington's Campus Safety services; crime prevention; on-campus housing policies; community member responsibilities; summaries of policies regarding alcohol, illegal drugs, sexual offenses and weapons; and crime statistics for the previous academic year. A copy of the current report can be obtained by contacting Office of Admission
02/2013