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Nomination Form

To nominate a candidate, please print and complete this form...

and return it, via US mail or by FAX, to WYSP, The Admissions Office, Wilkes University, Wilkes-Barre, PA 18766, fax 570-408-4904.

Name of Student ____________________________

 

High School  ___________________________

Date of Birth _______________________    SS# ___________________

 

Phone _________________     e-mail ____________________

Address __________________________________________    ZIP _________


Year of Graduation ___________    Class Rank _________

SAT: Math ________    Verbal _________

College Plan: ____________________________

Intended Major: ____________________________

Colleges to which you have applied or plan to apply for admission:

_____________________________________________________________________

Wilkes courses desired...

Fee, $70 per credit
Access the master course schedule for the upcoming term.

Choices Course-Section CRN Term-Year Time
Example: MTH-111-A 30665 Fall,2007 MTWF 8:00
__1st__ __________________ _________ _____________ ________________
__2nd__ __________________ _________ _____________ ________________
Alternate __________________ _________ _____________ ________________
Alternate __________________ _________ _____________ ________________


High school academic courses completed in the past year and in progress...
Course Term Grade   Course Term Grade
____________ ___________ _______   _______________ ___________ _______
____________ ___________ _______   _______________ ___________ _______
____________ ___________ _______   _______________ ___________ _______
____________ ___________ _______   _______________ ___________ _______
____________ ___________ _______   _______________ ___________ _______


Courses Completed at Wilkes...
_____________ ___________ _______   _______________ ___________ _______
_____________ ___________ _______   _______________ ___________ _______

 

Other courses or experience relevant to the desired Wilkes courses...

_____________________________________________________________________

_____________________________________________________________________

Nominated by...

Name & Position ___________________________

 

Signature _______________________________     Date ___________

 

 

Guidance Counselor/Principal___________________________ 

 

Signature _______________________________     Date ___________

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