Piedmont International University

Undergraduate Application for Admission
420 S. Broad St. | Winston-Salem, NC 27101 | 800.937.5097

Piedmont International University admits students of any race, sex, color, handicap, national, and ethnic origin
to all the rights, privileges, programs, and activities generally accorded or made available to students of the institution.

Personal Information

Last Name: First Name: Middle Name:
Address: City: State:
Postal Code: Country: Gender:
Phone Number:   Extension: Email:
SSN:**    Date of Birth:   City & St.
of Birth:
Country of
Marital Status:  
   Do you qualify
for military benefits?

Ethnic background (Providing ethnic information is voluntary and is gathered only for statistical reporting purposes.)
** Why is this needed?
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