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Graduate Studies, 108 RDI UW-River Falls 410 South 3rd Street, River Falls, WI 54022-5001 (715)425-3843
Required Information
Last: First Name: Middle:
Former Last Name: Email:
Social Security # *Inclusion of your social security number on this form is VOLUNTARY. If supplied, the number will be used as part of the university student record identification system. More
Birthdate (mm/dd/year) / /
Sex: Select Male Female Citizenship: Choose US Citizen Resident Alien Refugee Nonresident Alien
Country of Citizenship: Visa Status:
Veteran Status Have you and/or a parent or spouse served in the U.S. Military? (Check all that apply.): Select Self Parent/Spouse Neither
Racial/Ethnic Heritage (Please answer a. and b.) a. Ethnicity: Are you of Hispanic or Latino/a origin? No Yes (Please choose one) Select Cuban Mexican, Mexican American or Chicano/a Puerto Rican Other Hispanic or Latino/a
b. Race: Choose one or more from the list below.
African American or Black American Indian or Alaska Native Native Hawaiian/Pacific Islander Cambodia Hmong Laotion Vietnamese Other Asian White
Street Address (incl. apt. #): Since: /
City: State: Zip: County:
Mailing Address (if different):
Street Address: Apt. #
From To
Home: ( ) Work: ( )
Current Employer: Job Title: Dates of Employment: From to
Term Expected to Enter Select Fall JTerm (Winter) Spring Summer Year:
Indicate where you recieved your baccalaureate degree and all institutions of higher education attended
School #1: City From To Degree earned: Major
School #2: City From To Degree earned: Major
School #3: City From To Degree earned: Major
The following information is used to determine appropriate tuition rates. Review the following statements and select all that apply to you: I have lived continuously and only in Wisconsin since: (mm/yy). I have filed Wisconsin state income (not property) tax returns as a resident for the past 2 years. I recently moved to Wisconsin to begin fulltime employment and intend to maintain a permanent home in Wisconsin. (Some or all of the following may be required as proof: employer statement, WI driver’s license, voter/auto registration.) I graduated from a Wisconsin high school AND my parents have resided in Wisconsin for at least 12 months or did at the time of their deaths.
List former addresses, if any, during the last two years :
I want to be admitted as a TEMPORARY graduate student to take graduate level classes without receiving a degree or certification. I understand that the transcript and application fee requirements are waived for temporary students, but only 9 credits earned in temporary status may be applied toward a degree or certification program if I enter one at a later date.
An applicant who submits forged, altered, or falsified documents will not be admitted, and documents will be turned over to the proper authorities. I understand that submitting such documents is considered fraudulent and certify that the information provided on this form is truthful.
Type your full name here if you comply:
University of Wisconsin - River Falls 410 South Third Street River Falls, WI USA 54022-5001 (715)425-3911 Copyright © 1995-2009 University of Wisconsin-River Falls
