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About UA Wayne College
(current)
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Prospective Student
Please complete the following form
First Name:
Middle Initial:
Last Name:
Date of Birth: (Month / Day / Year)
Email:
Phone: (include area code)
Is this number a cell phone number?
Yes
No
Address:
City:
County:
Zip Code:
State:
I am a:
Transfer Student
New College Student
I am thinking of majoring in:
1st Choice:
2nd Choice:
Last School Attended:
Graduation Year:
GED obtained: (year)
Please send me information on:
Admissions
Financial Aid
Clubs and Activities
Credit for Life Experience
Veteran
Special Interests:
Associate degree (2 yr.)
Bachelor's degree (4 yr.)
What classes do you prefer?
Traditional - Day
Traditional - Evening
Traditional - Both Day and Evening
Web Enhanced
Online
What experience do you have in the health care field?
An asterisk (
*
) denotes a required field