Online Form

Date:
WKU ID (800 number, if applicable): (If you do not have an 800 number ID, please leave this field blank.)
Name:
Date of Birth: Maiden Name (if applicable):
Phone (with area code): Cell (with area code):
Home Address:
City: State: Zip: Gender: Male Female
E-Mail Address:
Have you ever been a WKU Student? Yes No Number of Hours (if known):
If yes, College and Department:
If no, Name of College/University attended:
Interested in a change of Major: Yes No Specify (if known):
Last date attended: Semester hoping to start:
How did you hear about Project Graduate: Finish WKU? (select all that apply): Alumni Magazine \| Media \| Postcard Mailing \| Word of Mouth \| Website \| CPE
Additional Comments/Notes: