Stout Online Registration


University of Wisconsin - Stout Online Registration Form

Term: 

   
   
   
   
 

* = Required fields

Enter either student ID# or SSN (no dashes).  If non-US citizen, enter 99999999

*UW-Stout Student ID:

 

*Social Security Number:

  


 Demographics

*Birthdate:
 Month fvd   Day     Year
        


*U.S. Citizen:

   
   
 
If no, what is your country of citizenship?

 


*U.S. Veteran:

   
   
 


Gender

   
   
 

Martial Status

   
   
 

Racial/ Ethnic Heritage: You are not required to disclose your racial/ ethnic heritage. However, your responses will help the UW System meet federal reporting requirements.

Ethnicity: Are your Hispanic or Latino/a origin?

   
   


If yes, choose one or more from the following list.
Cuban


Mexican Mexican American or Chicano


Puerto Rican


Other Hispanic or Latino/a  

Race: Choose one or more from the list below.

African American or Black


American Indian or Alaska Native


Native Hawaiian/ Pacific Islander


Cambodian


Hmong


Laotian  


Vietnamese


Other Asian


White



*First Name:

  

*Last Name:

   

Middle Name:


Maiden Name:


*Address Line 1:
Ex.1234 Stout Rd
 
*Address Line 2:
Menomonie Wi, 54751
 

Work Phone: (no dashes)
 


Work Email:

*Home/Cell Phone: (no dashes)
 


*Home Email:

Continuing Students: If you are now enrolled or were
registered through UW-Stout last semester stop here.

Scroll down to the course selection area.

New and Re-entering Students: If you were not registered
last semester please complete the entire form.

*Wisconsin Resident

   
   
 

If resident, how long have you lived in Wisconsin?
Month        Year
   


When was the last year you filed Wisconsin income tax?


Indicate the dates you have lived at your present address:
From;
Month    Year          
 


To;
Month    Year
 

 

Have you, your spouse or parent(s) recently moved to
Wisconsin to accept permanent, Full-time Employment?

   
   
 

Do you claim legal Wisconsin residency for tuition purposes?

   
   
 

List former addresses (Street, city, state, country) within
the last two years:
Former Address


From;
Month      Year
     

To;
Month      Year

 

Former Address



From;
Month     Year
 


To;
Month     Year
 

 

Occupations and Activities During the Last Two Years
Occupations, activity, school or employer address:




From;
Month       Year
 


To;
Month       Year
   




From;
Month       Year

 


To;
Month      Year
        


Graduate Credit Enrollees Only

 I have applied for admission to the graduate college at UW-Stout
in the past five years
   
   
 
 I have previously enrolled in a graduate course through UW-Stout
   
   
 
If so, I have been admitted to the following graduate program


I no longer want to pursue the above degree  


 Note: Students seeking/ changing a degree program must complete the application for Graduate Admission/ Enrollment form,
which is available from the Graduate college. 

 

Please send me the application material to apply to a  
graduate degree program.

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

List the high school you graduated from and any colleges, universities, or institutions that you have attended:


NameDegreeLocation
*High School:
        

Dates Attended:
From:(MM)From:(YYYY)To:(MM)To:(YYYY)

 
 
 
 
*Date Degree Awarded:
Month (MM)Year (YYYY)


 
 



NameDegreeLocation
College/University:        

Dates Attended:
From: (MM)
From: (YYYY)
To: (MM)
To:(YYYY)

 
 
 
 
Date Degree Awarded:
Month (MM)Year (YYYY)



 
 


Have you previously taken courses through UW-Stout either on or off campus?

   
   
 

If yes, list date of last enrollment


Do you plan to continue at UW-Stout?
   
   


*Intended Major/Program


Select academic level
   
   
 

*Course Subject

*Course ID #
*Sec. #

*U/G
Cr.

*Course Title

*Credit #
Meeting
Times
DaysBegin
Date
End
Date
Locations
Example:   Engl101800A*U
Intro to Stout
28AM - 1PM
Sat6-148-14Menomonie
   
  
    

*Type of credit: U=Undergraduate, G=Graduate

*I plan to apply credit toward:

*Signature Required
I certify that the information in this application is true and complete to the best of my knowledge and I understand that inaccurate information
may affect my enrollment or financial aid status. If I enroll at this university, I expect to be subject to its rules and regulations.



*Date
  mm/dd/yy

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