WVSU | West Virginia State University

Student ID# (A Number): *

Last Name: *

First Name: *

Middle Initial:

Current Address: *

Permanent Mailing Address (If different from above):

Phone (Primary): *

Phone (Secondary):

WVSU Email:

@wvstateu.edu addresses only

Alternate Email :

Date of Birth

Month: *

Day: *

Year: *

4 digit year

College: *

Major: *

Credit Hours Completed: *

GPA: *

Expected Graduation Date: *

Classification: *

Race/Ethnic Data

Please provide the following race/ethnic data. This information is requested on a voluntary basis by the U.S. Department of Education (check all that applies). This information will not affect your admission to the program.

Race:

Race (Other):

Please specify if you selected "Other" on the above question

Non-WVSU Students

If you are not a WVSU student, please attach a copy of all college transcripts and provide the name and contact information for a faculty member who would be willing to serve as a reference.

EO/AA Statement

West Virginia State University and the West Virginia State University Gus R. Douglass Institute is an equal opportunity, affirmative action institution that does not discriminate on the basis of race, color, religion, sex, national origin, age, disability, or veteran status in its employment, programs, or activities. Individuals with disabilities are encouraged to participate and apply.

Honors Program Application Form