University of Wisconsin - Stout

Benchmark I Application:
Acceptance into Teacher Education Program and
Pre-Student Teaching Experiences

Name:
Student ID:
Major:
   
Home Mailing Address:
City:
State/APO/FPO:
Zip:
Home Telephone:
   
School Mailing Address:
City:
State/APO/FPO:
Zip:
School Telephone:
   
E-mail Address:
 
 

By typing my name below, I certify that the information provided above is truthful and accurate to the best of my knowledge and that knowingly providing false information or omitting information may result in an ineligibility to interview for the Benchmark I Interview.

Type name here: Date: