Summer and WinTerM Registration Form


University of Wisconsin - Stout Registration Form

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

Do you plan to participate in the University of Wisconsin - Stout Study Abroad program? 


If you plan to continue in the next semester, go to 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
( 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)
 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)



To (ex. 05/2014)

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


From (ex. 05/2014)



To (ex. 05/2014)




Additional Addresses


From (ex. 05/2014)


To (ex. 05/2014)




Parents Name



Parent's Address (last two years)


From (ex. 05/2014)


To (ex. 05/2014)


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)


To (ex. 05/2014)


Additional Occupations/Activities 



From (ex. 05/2014)



To (ex. 05/2014)


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


Hawaiian or Pacific Islander





Other Asian

Mexican, Mexican American, or


Other HIspanic or Latino/a

Puerto Rican

White or Caucasian

I choose not to respond

 U.S Veteran
 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)


 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

Please sign here by typing your first and last name 



and entering the date