Admissions bachelor of arts in general studies International Graduate Undergraduate Admissions Western Illinois University

Graduate Application for Readmission

Section I -- Personal Information
Last Name:
First Name:
Middle Name:
Previous Name:
Social Security Number: - -
WIU Identification Number:
(if applicable)
- -
Last Term Attended:
Date of Birth: ,
Military Service: Have you served or are you serving on active duty with the armed forces? If yes, provide dates of service: to
National Guard or Reserve duty?

E-mail Address:
Important information will be sent to this address. Ensure that it is valid.
Confirm Email:
Please re-enter your e-mail address to confirm.
Permanent Address:
Postal Code:
Home Phone: () -
Cell Phone: () -

If your Current Address is the same as your Permanent Address above, leave the following fields blank.
Otherwise, please provide complete Current Address information.

Current Address:
Postal Code:
Phone: () -

Section II -- Application Information
Applying As: 
Degree-Seeking Student
Degree Major:
* Major available at Macomb and Quad Cities campuses
** Major only available at Quad Cities campus

Nondegree-Seeking Student
2nd Bachelors Major:
*Major available at Macomb and Quad Cities campuses
Post Bacc. Certificate:
*Certificate also available at WIU-Quad Cities campus
**Certificate ONLY available at WIU-Quad Cities campus
Applying For:
Location: Macomb campus
WIU-Quad Cities

If you are applying for a different graduate degree major than that on your previous application and already have a personal goals statement and letters of recommendation on file, do you want those documents to be used for admission to the new program?
Not applicable, I am not applying for a different degree program.
Yes, please use all the former documents for the new program major.
No, I will be submitting both new personal goals statement and letters of recommendation.
No, please send the former letters of recommendation but I will submit a new personal goals statement.
No, please send the former personal goals statement but I will submit new letters of recommendation.

Educational History:
List all colleges or universities attended since LAST attending WIU
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If you have any questions or comments please let us know
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Criminal Record Disclosure Policy
Western Illinois University is committed to maintain a safe and positive environment for all members of the University community. Therefore, you are required to disclose information regarding your criminal or disciplinary background.

A) Have you ever been convicted of, or been placed on court supervision for any criminal offense? (This does not include routine traffic offenses) Yes No

B) Do you have any criminal charges pending against you? Yes No

C) Have you ever been dismissed, or withdrew while charges were pending from any educational institution (including but not limited to high school or college) for any offense involving violence or the threat of violence? Yes No

If you answered "yes" to any of the questions above, please submit a description of the incident(s), including name, date of birth, date of incident(s), location of incident(s), name of arresting agency(s) as well as any additional relevant documentation. Additionally, please request the Circuit Clerk of the Court(s) in which the order of conviction(s) was entered and forward these record(s) to:

Western Illinois University, School of Graduate Studies, ATTN: Campus Violence Prevention Enrollment Committee, 1 University Circle, Macomb IL 61455. These cases will be reviewed prior to an admissions decision being made. Such disclosures do not automatically disqualify an applicant.

This application must be signed and dated by the applicant before action can be taken. I understand that withholding information requested on this application or giving false information may make me ineligible for admission to the university or subject to dismissal. I certify that the information provided on the application is correct and complete.

By signing this I also certify that I have read, and will adhere to all the components of the Criminal Record Disclosure Policy as stated.

Verify the following:
By checking this box I certify that I am personally seeking admission to Western Illinois University and all information supplied on this application and all credentials submitted are complete and accurate to the best of my knowledge and belief. I understand that withholding information requested on this application or giving false information on this or any WIU document may make me ineligible for admission to the University or subject to dismissal.

Please take time to review your information before completing your application.
Application information will be immediately submitted once button is clicked.

Board of Trustees International Graduate Student Services
1 University Circle | Sherman Hall 116 | Macomb, IL 61455-1390
Phone: (309)298-1806 | Fax: (309)298-2345 | E-mail:
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