Application Form Western Michigan University

Fill out the form carefully for registration

Personal Details

Student Name (as in passport)



Nationality (as in passport)

Country of Birth

Mobile Phone

Email Address

Postal Address

City / Regency

State / Province


Postal Code

Father's Name

Mother's Name

Father's Email

Mother's Email

Father's Phone Number

Mother's Phone Number

Intake and Programs

Please indicate which intake and program you are applying for:

WMU Program

Intake Month

Year of entry

Degree Preferences (Optional)

Uni. Preferences (Optional)

Application Details

Are you citizen of United States of America?

Have you previously applied to another WMU campuses

The application form is submitted by

Specify The Name


School / Institution Name



Year / Level


English Language Proficiency

English was the language of instruction in previous studies completed

I have sat for IELTS / TOEFL iBT. The result is

Declarations & Signature

  1. I declare that I have read the instructions on this application form and that the information provided by me is true and complete. I recognize that it is my responsibility to provide all necessary documentation to support my application and I authorize JIC to obtain further relevant documentation where necessary.
  2. I acknowledge that JIC reserve the right to vary or reserve any decision regarding admission or enrollment made on the basis or incorrect or incomplete information.
  3. I accept that JIC is a branch of Western Michigan University, USA. JIC is not responsible for the Student Visa to U.S. as it is under U.S. Embassy authority. For student visa requiremens, please check the website:

I have read and understand the above conditions and am prepared to accept them in full.

Signature (Student)

Signature (Parent / Guardian)