Washburn Institute of Technology
5724 SW Huntoon
Topeka, KS 66604
785.273.7140
Fax: 785.273.7080
www.washburntech.edu


Application for Admission


Inputs marked with a red asterisk (*) are required.

Date of Application: 7/25/2021
1. Applicant Information * Date of Birth: (Please enter in this format: mm/dd/yyyy)
* (Legal Name) Last * First Middle Suffix Other Name(s) if any
* Street Address (This is where ALL school-related mail will be sent) * City * State * Zip
* Home Phone Cell/Other Phone * Email Address
 
May we contact you via text?  Yes   No If yes, which carrier do you use?   Or, Other:

We are asking for your help in responding to a variety of requests from federal and state agencies for data describing our students and staff. Because we want to ensure all our students have the best opportunity to succeed at Washburn, this data may also be used internally at Washburn to identify resources for you individually that are available and have assisted others in achieving success as a student at Washburn. Reporting this information is voluntary and it will be treated as confidential information.
Questions about this data collection may be addressed to Pam Foster, Equal Opportunity Director, eodirector@washburn.edu.
If you have a U.S. Social Security Number, please enter it here:
 
Gender:
Are you a U.S. citizen?
 
If no, are you a Lawful Permanent Resident of the U.S.?
  If yes, please enter your Alien Registration Number:
  and submit a copy of your Permanent Resident Card (Green Card) to the WIT Office of Admissions
 
If you are currently in the U.S. on an immigrant or non-immigrant visa, please enter the visa type here:
 
Important note: Applicants who are on the following visa types are not eligible to enroll in courses at the Washburn University Institute of Technology because of U.S. Citizenship and Immigration Services (U.S. CIS) restrictions: F-1 Student, J-1 Exchange Visitor or B-1/B-2 Visitor for Business or Tourism
A veteran is a person who once served, but does not currently serve, in the Active Duty, National Guard, or Reserve forces of the United States military services. Please indicate your status as a veteran, spouse, or dependent of a veteran below.
 
Is your parent, guardian, or spouse currently on Active Duty, in the National Guard, or in the Reserve forces of the United States military services?
 
Are you currently serving in the Active Duty, National Guard, or Reserve forces of the United States military?

* List program(s) at Washburn Institute of Technology in which you are interested (minimum of one):
1.
2.
3.
Other:
 
* Preference:  Morning (8:00am-11:10am)   Afternoon (11:45am-2:55pm)   Full-day (8:00am-2:55pm)   Evenings (varies)
 
* Desired Start Term:
2. Educational Information
* Are you currently attending high school?  Yes   No
* Have you previously attended Washburn Institute of Technology?  Yes   No
3. Contact Information
High school students: List someone other than your parents/guardians. Parents/guardians will always be the first attempted contact in an emergency.
* Emergency Contact 1:
  Name Relationship Daytime Phone #
Emergency Contact 2:
  Name Relationship Daytime Phone #
4. Financial Aid/Veteran's Information   (Please Note: High school students are not eligible to receive Federal Financial Aid)
Please first select if you currently attending high school in Section 2 above.
5. Other Information
* I give my consent that pictures may be taken of me and may be used by Washburn Institute of Technology for promotional purposes, and these pictures may be used in printed form, on television, or on the World Wide Web.
 Yes   No
* Have one or both of your parents attended school beyond the high school level?  Yes   No
* Foster Care Eligible?  Yes   No
(Eligible individuals in the foster care system are exempt from tuition/fees per state statute.)
* How did you hear about us?   Other:
6. Signature
I have read and understand the contents of this application for admission to Washburn Institute of Technology. If accepted as a student at Washburn Institute of Technology, I agree to abide by the rules and regulations of the school regarding conduct, tuition and fees and other obligations. I understand that any misrepresentation or falsification of application information could lead to my dismissal.
 
7/25/2021
* Signature of Applicant (Type your full name to sign) Date
 
7/25/2021
Signature of parent, if applicant is under age 18 (Type full name to sign) Date