Summer and WinTerM Registration Form


University of Wisconsin - Stout Registration Form

Have you Graduated from High School? 

High School Graduation Date:
Month (ex. 09)          Day (ex. 22)          Year (ex. 2015)

If you are in High School and want to take a class, Please Stop Here. Please go to and complete the UW System application for admission.

If you have already been accepted, please continue to fill in the form below.

 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


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