Nomination 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:

_____________________________________________________________________

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

_____________________________________________________________________

_____________________________________________________________________

Name & Position ___________________________

Signature _______________________________     Date ___________

Guidance Counselor/Principal___________________________ 

Signature _______________________________     Date ___________