University of Wisconsin-Milwaukee

Something Great in Mind

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* Required Information for All
* Required Information for US Residents Only
 * Current High School Students Only
*Birth Date
(Will be kept confidential)
Format: MM/DD/YYYY
  / / 		*Gender:
    
 
Prefix:
 

*Formal First Name:

 Middle Initial:
 *Last Name:
 Suffix:
  

 
*Country:
  

*Street Address:

 APT/STE/UNIT:
    

 
*City: *State:
 *Zip Code:
        
Telephone Number:
/ - 		*Email Address:

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*H.S. Name:
(If your school is not in the list, leave blank)
  
*Term of High School Graduation:  
Race/Ethnicity: Please answer both A. and B.
 
A. Ethnicity - Are you of Hispanic or Latino orgin? If yes, chose one or more from the list below.   B. Race - Choose one or more from the list below:
Mexican, Mexican American, or Chicano   African-American or Black
Puerto Rican   American Indian or Alaskan Native
Cuban   Hawaiian or Pacific Islander
Other Hispanic or Latino   Cambodian
    Hmong
    Laotian
    Vietnamese
    Other Asian
    White or Caucasian
    I choose not to respond
*Are you a US Citizen?
Yes No		      
*Planning to Enter UWM:
     *Will Be:
Major 1:
     Major 2:
Major 3: