Panther Overnight Registration Form

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Panther Overnight Registration Form

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Complete the form below to register for UWM Panther Overnight Program (forrnerly known as Camp-In). This event has a $30 registration fee. Please make checks payable to UWM. Include the student's name and the date of the event on the check and mail it to:

Department of Recruitment and Outreach
Kim Huettl, UWM Panther Overnight Program Coordinator
P.O. Box 2174
Milwaukee, WI 53201
414.229.5018

Space is limited. Register and send in payment early, programs tend to fill 2-4 weeks in advance. Students are required to attend the entire program which begin Sunday 4:00 p.m.(optional tour at 3:00p.m.) and end Monday, 3:00 p.m.

REGISTER NOW using the form below!

I am interested in attending the following date:

First Name:

*Last Name:

Middle Initial:

Date of Birth:

(ex. 01/01/1992)

Gender:

Address:

Street, City, State, Zip

* City:

State:

* Zip Code:

Phone:

E-mail:

Parent email address:

High School Attending:

If homeschooled, write homeschool

ACT/SAT score:

High School GPA:

* High School Graduation Year :

Are you a Wisconsin Covenant student?:

Yes

Intended Major at UWM:

Preferred t-shirt size:

Total number of guests attending:

Not including the student

Do you plan to take the optional 3-4pm tour?:

Yes

Are any special accommodations needed?:

Yes

(i.e. wheelchair, sign language interpreter, etc)

If yes, please indicate type of accommodation needed:

(i.e. wheelchair accessibility, interpreter, etc.)

A. Ethnicity: Are you of Hispanic or Latino origin?:

Yes

If yes to Ethnicity A. question, please choose one or more from this list to the right:

Mexican / Mexican American or Chicano

Puerto Rican

Cuban

Other Hispanic or Latino

Part B. Race: Choose one or more from this list::

African American or Black

American Indian or Alaskan Native

Native Hawaiian or Pacific Islander

Cambodian

Hmong

Laotian

Vietnamese

other Asian

White

I choose not to respond

tribal affiliation / other:

If you checked off American Indian, Alaskan Native or other, please specify here