University of Wisconsin-River Falls

GRADUATE STUDIES RE-ENTRY FORM

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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

I am a returning UWRF graduate student Graduate students whose last class at UWRF was prior to Fall 2003-2004 must re-enter.

Personal

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: Citizenship:

Country of Citizenship: Visa Status:

Veteran Status: Racial/Ethnic Heritage:

Address

Street Address: Apt. # Since: /

City: State: Zip: County:

Mailing Address (if different):

Street Address: Apt. #

City: State: Zip: County:

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Telephone Number(s)

Home: ( ) Work: ( )

Semester

Term Expected to Enter Year:

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University of Wisconsin - River Falls
410 South Third Street River Falls, WI USA 54022-5001 (715)425-3911
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