Summer and WinTerM Registration Form

 

University of Wisconsin - Stout Registration Form
   
   

 Do you plan to continue at UW-Stout the next semester?
   
   

If you plan to continue in the next semester, go to https://apply.wisconsin.edu/ and complete the UW System application for admission.
Continuing Students: Stop here if you are now or were enrolled at UW-Stout last semester. You may register through Access Stout.
Admitted Students: If you are already admitted for a term stop here. Please contact the Registration and Records Office via email
(registrar@uwstout.edu) to enroll.
Have you attended or applied to UW-Stout in the past? 

   
   

New and Re-Entering Students: Please complete this registration form.

 

Social Security Number

(No Dashes)
 Last Name
   
 First Name
      
 Maiden Name (If Applicable)
   

 

Email Address

 
 Home/Cell Phone (No Dashes)
     
 Permanent Address line 1
(ex. 1232 Stout Road)
      

Permanent Address line 2
(ex. Menomonie, WI 54751)
 


Residence Data (It is your responsibility to register correctly as a resident or non - resident according to law)

 Wisconsin Resident?
 
   
   
  If Resident how long have you lived in Wisconsin? (ex. 05/2014)
since:
  (month/year)
 When was the last year you filed Wisconsin Income Tax? (ex. 2014)
 
 Have you, your spouse or parent(s) recently moved to Wisconsin
  to accept permanent full-time employment?
 
   
   
 Do you claim legal Wisconsin residence for tuition purposes?
 
   
   
 
 

Indicate the dates you have lived at your present address:
 
From (ex. 05/2014)

  (month/year)

 

To (ex. 05/2014)
 
  (month/year)
 

List former address (Street, State, Country) within the last two years
 
   

 

From (ex. 05/2014)

  (month/year)

 

To (ex. 05/2014)

 

  (month/year)

 

Additional Addresses

 
 

From (ex. 05/2014)

  (month/year)

To (ex. 05/2014)

 

  (month/year)

 

Parents Name

   

 

Parent's Address (last two years)



 

From (ex. 05/2014)

  (month/year)

To (ex. 05/2014)

  (month/year) 
 

List High School that you attended:



City of High School attended





State of High School attended

 


Occupation and Activities during the last two years

   

From (ex. 05/2014)

  (month/year)

To (ex. 05/2014)

  (month/year)
 

Additional Occupations/Activities 

 

 

From (ex. 05/2014)

 (month/year)

 

To (ex. 05/2014)

 (month/year)

 Demographics:
 Birth Date (Month/Day/Year)
 Ethnic Background (Check All That Apply)  


African-American


Hawaiian or Pacific Islander


Cambodian


Hmong


Laotian


Vietnamese


Other Asian


Mexican, Mexican American, or
 Chicano/a


Cuban


Other HIspanic or Latino/a


Puerto Rican


White or Caucasian


I choose not to respond

 U.S Veteran
   
   
 
 Sex
 
   
   
 
 Marital Status
 
   
   
 
 

Are you a citizen?

 

   
   
   

 

If not a U.S Citizen, check one:

Refugee/Granted Political Asylum

Visa Holder
If Visa Holder please give visa type:


Resident Alien
If Resident Alien please give registration number
 

 

I intend to request a Visa

 

   
   
   

 

Country of Citizenship

     

 

Place Of Birth

(city)/ (state)


  (country)


 Graduate Credit Enrollees Only

I am currently a graduate degree seeking student at UW-Stout

 

   
   
 

I plan to take courses as a Non-Degree special student for transfer or to
extend my education. (This does not constitute application/admission
to a degree program)

   
   
 
SubjectCrs#SecG/UGCourse Title
CrMeeting Times
DaysBegin Date
End Date
ENGL101001UComposition 1
38:00 - 9:50am
M-F6/247/9
           
  
          
          

Please sign here by typing your first and last name 

 

 

and entering the date

    mm/dd/yy