Residency Form

This form must be completed by all admitted students.

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Return to:
Washburn University School of Law
Attn: Admissions Office
1700 SW College Avenue
Topeka, KS 66621-1140
(800) 927-4529

Name: _____________________________________________________________
      Last              First                Middle         Other Last

Male ____   Female____

SS# _______________________     Date of birth: ___________
                                               Mo. / Day / Yr.

Are you a U.S. Citizen? Yes ____   No ____

    If no, which country do you have citizenship? _________________
    If no, provide your Alien Registration Number: ________________

Will you be attending the Washburn University School of Law as an F-1
 or J-1 visa holder? Yes ____   No ____
 Please specify Visa Type: ____________________

Current Residence: ________________________________________________
                 Street                                            City
                 __________________________________________________
                 County                      State                 Zip

        From: _____ / _____ to _____ / _____
              Month / Year     Month / Year

Permanent Residence: ______________________________________________
                    Street                                            City
                    _______________________________________________
                    County                      State                 Zip

        From: _____ / _____ to _____ / _____
              Month / Year     Month / Year


Are you a registered voter? Yes ____   No ____

If yes, where: ____________________________________________________
               City                 County                  State

Do you own a vehicle? Yes ____   No ____

If yes, ___________________________________________________________
         Vehicle License No.               State & County Registered

Will you graduate from a university/college outside of Kansas
   this year? Yes ____   No ____

Did one or both of your parents graduate from Washburn?
   Yes ____   No ____
   If yes, ___________________________________________________________
            Name                                        Graduation Year

Are you on active-duty military? Yes ____   No ____
Are you a dependent of someone on active-duty military
   stationed in Kansas? Yes ____   No ____


I certify the above information is correct and complete:

___________________________________________________________________
Signature of Student Applicant                             Date



                       For University Use Only

Degree ________________       Graduation Class ___________

Class _________________       Residence	__________________

Semester ______________

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