University of Wisconsin - Stout

Personal Information

Name: *Required

Stout ID#:

E-Mail Address:

Website:

Address:

City:

State:

Zip:

Telephone#: (include area code)

Major/Concentration: * Required

Graduation Date: * Required

Did you register with the Career Services Office?
Yes
No
If employed, is your job the result of a co-op experience with the company?
Yes
No

Position Information    (Complete if employed)

Position/Job Title: * Required if employed

Status:

Full-time
Part-time    * Required if employed

Employer:

* Required if employed

Address:

State: Zip:


Telephone#:

Annual Salary: * Required if employed

Did you receive a signing bonus?

Yes        Amount:  
No
Would you consider this position within your major? * Required if employed.
In major
Related to major
Out of major
If you have not graduated what is your anticipated graduation date?
I will be continuing my education at:

If not employed, please check one.   Seeking Employment   Not Seeking Employment
Would you like a counselor to contact you regarding your employment status?
Yes
No

Please print a copy of this form after it is filled in for your own records.