Honors Program Application

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:

College:

Major:

Credit Hours Completed:

GPA:

Expected Graduation Date:

Classification:

Race/Ethnic Data:

Security code:

Enter security code: