On the Spot Application Form

Please fill out the UW-Parkside application form below.

If you have questions please email admissions@uwp.edu or call 262-595-2355

First Name

Middle Name/Initial

Last Name

Birthdate

Mobile Phone Number

Hispanic/Latino Origin

Yes

No

Cuban

Mexican

Puerto Rican

Mexican, Mexican American, or Chicano/a

Race (Choose one or more from the list)

Current Home Address

Country

Street

City

Region

Postal Code

Length of time at your current address:

From:

To:

Have you lived at your current address for 12 months or more?

Yes

No

Previous Home Address

Country

Street

City

Region

Postal Code

Length of time at your previous address:

From:

To:

High School Name

Email Address

Date of Expected HS Graduation

Self Reported GPA (Please use this format: Example: 3.25)

Have you taken any Dual Credit Courses?

Yes

No

Have you attended any other schools?

Yes

No

Previous High School Name

Major of Interest

Please type in your first and last name as an electronic signature:

You are ready to sign your application. Once you sign and submit your application you are not able to make changes to your submitted application(s).

I acknowledge that by providing an electronic signature, I attest to the accuracy and truthfulness of the application(s) I'm submitting.

Signature:

Today's Date: