Class Registration Form

First Name:

Last Name:

Current Address:

City:

State:

Zip Code:

Telephone Number:

Email Address:

Are you a UWM student?:

Yes

Referral Source:

When applicable, please refer to the information on your citation when providing this information.

Other Agency's Name:

Case or Citation Number:

When applicable, please provide the full citation number, including all letters and numbers.

Court date or date by which University Housing sanction must be completed:

mm/dd/yy

Questions, Comments, Concerns:

University of Wisconsin–Milwaukee