1.	First Name*

2.	Middle Name

3.	Last Name*

4.	Email Address

5.	Date of Birth*
	mm/dd/yyyy

6.	Student Type*
	Freshman Transfer Special Undergraduate Other, please specify

7.	What reason did you choose not to attend UNCW?*
	Financial Aid Too close to home. Too far away from home. Removed from waitlist at school of choice. Academic area of interest not offered. Other, please specify

8.	Please let us know what university or college you plan to attend.

9.	If you would like the UNCW Office of Admissions to contact you further, please provide a current phone number and best time of day to call.

10.	I understand that by checking "Yes" below, I will be withdrawing my application for admission at The University of North Carolina Wilmington and I certify that I am the person named above and that I am submitting this request for my own admission application. *
	Yes No