Wayland Baptist University

General Information

 Required fields are marked with an asterisk (*).
* Last Name:  
* First Name:  
Middle Name:
Preferred Name:
* International Student:  
* Gender:  
Birth Date:
* Permanent Address:  
* City:  
* State:  
* Home Phone  
Cell Phone:
* Email Address:  
High School you attend(ed):
Graduation Year:
Religious Preference:
Home Church:
Full name of father/guardian:
Father's Occupation:
Father's Business Phone:
Full name of mother/guardian:
Mother's Occupation:
Mother's Business Phone:

Immunizations required for Housing Assignment

* Have you had a meningitis
If so, please upload documented proof of your vaccination to Magnus Health:

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