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Interest Page 3.0

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Please fill out the fields below and submit the form. Some information is required and marked with asterisks. You will not be able to submit the form without filling the required fields. Please make sure that Email and Verify Email should match with each other.

Student Information

I am a: *

Are you an International Student *

Do you want to take online or on campus classes?

Basic Information

Full Name

First Name *

Middle Name

Last Name *

Suffix

copy Preferred Name

Gender

DOB *

Ethnicity (Please check all that apply)

American Indian/Alaska Native
Asian/Pacific Islander
Black/African American
Hispanic/Latino
Native Hawaiian/Other Pac Island
Not Indicated
White

Contact Information

E-mail *

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Skype ID

Country *

Address Line 1

Address Line 2

City *

State

Foreign Province

Zip

Phone

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Cell Phone

May we text you

Parent 1 Email

Country of Citizenship

Enrollment Information

Primary Area of Interest

Primary Program of Interest

Secondary Area of Interest

Secondary Program of Interest

Entry Term

English Proficiency Information

English Proficiency Test

English Proficiency Test Score

Test Date

Other Information

Are you a Veteran, spouse or a child of a Veteran?

Yes
No

Are you Wisconsin Covenant Student

Yes
No

General Information

How did you hear about us?

Advertising
Alumni Referral
College Fair
Educational Agent/Advisor
Facebook
Family/Friend
High School Counselor
Internet Search
Mailer
Other

How did you hear alumni

How did you hear family/friend

How did you hear other

What is your level of interest

On-Campus Activities

Campus Activities you want to be involved in

BandTheatre
ChoirMen's Baseball
Community Service/VolunteerismMen's Basketball
Danceline/CheerleadingMen's Cross Country
Intramural/Club SportsMen's Hockey
Journalism/NewspaperMen's Soccer
LeadershipMen's Track
Mock TrialWomen's Basketball
Model UNWomen's Cross Country
OrchestraWomen's Hockey
Outdoor Adventure/Recreational SportsWomen's Soccer
Student Activism/DiversityWomen's Softball
Student GovernmentWomen's Track
Study AbroadWomen's Volleyball

Please indicate primary instrument /voice type

Please indicate secondary instrument/voice type

Educational Information

High School Name

High School Code

Find your code here.

College Name

College Code

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Are you currently enrolled in the University/College listed above?

Yes
No

Login Information

Password *

Verify Password

Hidden Attributes

Inquiry Date

Program Action

Application Center

Web Referral Source

Hidden Attributes

High School Address1

High School Address2

High School City

High School State

High School Zip

College City

College State

College Zip

Admissions Requirements

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University of Wisconsin-Superior is an equal opportunity educator and employer

University of Wisconsin-Superior

Wisconsin's Leading Public Liberal Arts College

Student Information

Basic Information

Contact Information

Enrollment Information

English Proficiency Information

Other Information

General Information

On-Campus Activities

Educational Information

Login Information

Hidden Attributes

Hidden Attributes