Young Scholars Application

Applicant Information

First Name

Middle Name

Last Name

Preferred Name

Email Address

Social Security Number

Sex

Birthdate

Citizenship

Mailing Address

Country

Street

City

Region

Postal Code

Home Phone Number

Mobile Phone Number

Religious Affiliation

WELS Church Name

Educational Information

Name of High School

HS CEEB

Anticipated Graduation Year

Academic Interest

What semester do you intend to take class?

Intended Year

Intended Term

What course(s) do you intend to take? Please list each course separately.

Course 1

Course 2

Course 3

Course 4

Family Information

Father/Guardian

Dr.

Mr.

Rev.

First Name

Last Name

Mailing Address (if different than applicant)

Country

Street

City

Region

Postal Code

Marital Status

Occupation

Phone Number

Mother/Guardian

Dr.

Mrs.

Ms.

Rev.

First Name

Last Name

Mailing Address (if different than applicant)

Country

Street

City

Region

Postal Code

Marital Status

Occupation

Phone Number

The undersigned hereby certifies that the information provided above is accurate and complete and agrees to comply with the current policies and regulations pertaining to the academic and social life of Wisconsin Lutheran College students as stated in the college catalog.

Signature

Date

Wisconsin Lutheran College does not discriminate against qualified individuals on the basis of race, color, disability, national, or ethnic origin in its recruitment, admission, educational, or administrative policies, scholarship and loan programs, and athletic and other school administered programs. The college also is committed to admitting student athletes who will demonstrate a level of success consistent with that of all students on campus. Male and female student athletes will receive fair and equal treatment.

Wisconsin Lutheran College is affiliated with the Wisconsin Evangelical Lutheran Synod. The college reserves the right to make changes affecting policies, fees, curriculum, and other matters in this publication.