JumpStart - Account & Registration Request

Please enter your information in each of the following sections. Fields with a asterisk (*) are required and must be completed before you can submit your application. Please review your application carefully reviewing your personal email address correctly (do not use a high school email account). Failure to check and respond to your email may impact your application and registration status.

This information will be included in your WSU Tech student record.

First Name*

Last Name*

Middle Initial

Preferred Name

Citizenship Status*

Social Security Number*

WSU Tech is required under IRS regulations to provide a Form 1098-T to each student enrolled in a course that offers college credit. This also includes high school students enrolled through their high school. WSU Tech is also required to request the student’s Social Security Number to include on the 1098-T

Email*

Please use a personal email address so you can receive communication from JumpStart Administrators. Many high school email accounts do not accept mail from outside of your high school.

Confirm Email*

Password*

Please choose a strong password, with min. 8 characters, at least 1 digit and 1 uppercase letter

Retype Password*

Gender*

Date of Birth*

Enter date as mm/dd/yyyy

Cell Phone Number (10-digit)

10 digits (i.e. 5551231234)

By checking box, I opt-in to receive text message notifications. Standard message and data rates apply.

Mailing Address

Address Line 2

City

State

Zip Code

High School*

Grade level

High School Graduation Month and Year*

Are you of Hispanic or Latino descent?

Regardless of your answer above, please select one or more race(s) that you identify with:

American Indian/Alaska Native

Asian

Black/African American

Native Hawaiian/Other Pacific Islander

White

Parent/Guardian First Name*

Parent/Guardian Last Name*

Parent Email

What is the highest level of education that your mother completed?

What is the highest level of education that your father completed?

I certify that the typed name, address, and date of birth above is correct. This information will be used to create a PERMANENT college transcript and must be accurate. I certify that all of the information submitted on this application is my own work, factually true, and honestly presented.

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