APPLY ONLINE: apply.wisconsin.edu

A P P L I C A T I O N D E A D L I N E S F a l l T e r m : F e b r u a r y 1 | S p r i n g T e r m : O c t o b e r 1APPLICATION FEE (nonrefundable) Freshmen: $44 | Trans fer Students: $44* | Reentr y Students: no fee

*Transfer students whose last institution attended is a two-year UW Colleges (freshman/sophomore) campus do not need to pay the $44 fee.

undergraduate

2011-12ADMISSION APPLICATION

EMILY JULKA

Application SubmissionApply online at apply.wisconsin.edu or use this paper application. If you use the paper application, send it to: University of Wisconsin–Madison Office of Admissions Armory & Gymnasium 716 Langdon Street Madison, WI 53706–1481

For information about other campuses in the University of Wisconsin System, contact the Higher Education Location Program (HELP) at 608–263–4567 or 1–800–442–6459, or visit www.uwhelp.wisconsin.edu. For students who do not intend to earn a degree at UW–Madison, but who wish to enroll in courses for a semester or summer session, contact the Division of Continuing Studies, 21 N. Park Street, Room 7101, Madison, WI 53715–1218, 608–263–6960, or assc@dcs.wisc.edu. Do NOT complete this application.

Application FeeFreshman and transfer applicants must submit a $44 non -refundable fee. Pay the fee by check, money order, or bank draft, payable to University of Wisconsin. Do not send cash. You must send the fee with your application. If you apply online, you may also pay by credit card. Transfer students whose last institution attended is a two-year UW Colleges (freshman/sophomore) campus and reentry students are not required to pay an application fee.

Application DeadlinesBe sure to submit your application and all required materials by February 1 for the fall term and by October 1 for the spring term.

Application Instructions(Refer to item number in brackets.)Social Security Number (3): Federal law allows the university to request and use your Social Security number (SSN). If you intend to apply for financial aid or the educational tax benefit, you are required to provide your SSN. If you do not intend to apply for financial aid, providing your SSN is optional.

Race/Ethnicity (7): You are not required to disclose your race/ethnicity. However, you are strongly encouraged to do so. Having this information will help us provide effective programs to the heterogeneous population we seek to serve. Please check the category that most accurately reflects your heritage. American Indian and Alaskan Natives are encouraged to enter tribal affiliation in addition to checking the appropriate category.

Applying As (19): Choose the category that pertains to you.m New Freshman: has not attended a postsecondary institution beyond the summer

following high school graduation.m Transfer: has attended a postsecondary institution after the summer following high school

graduation. (Note: Transfer students are not accepted at the freshman level.)m Reentry: was once registered at UW–Madison in an undergraduate degree program but has

not attended UW–Madison for a semester or more (excluding summer term) and intends to pursue a UW–Madison degree.

m Nondegree/Special: plans to take classes for credit but not toward a UW–Madison bachelor’s degree; has typi cally earned a degree. (If this is your situation, do not use this application. Instead, use the “Special Student” electronic application available online at apply.wisconsin.edu or request a paper application from the Division of Continuing Studies by phoning 608–263–6960 or e-mailing assc@dcs.wisc.edu.)

m Summer Only: plans to attend the summer session only, with no intention of earning a degree at UW–Madison. (If this is your situation, do not use this application. Instead, use the “Special Student” electronic application available online at apply.wisconsin.edu or request a paper application from the Division of Continuing Studies by phoning 608–263–6960 or e-mailing assc@dcs.wisc.edu.)

m Second Undergraduate Degree: has already earned a four-year bachelor’s degree and intends to earn a second undergraduate degree.

m Additional Major/Minor/Certification: has already earned a four-year bachelor’s degree and intends to complete additional coursework; affiliated with a particular UW–Madison school or college.

Residency InstructionsWisconsin Statutes, Section 36.27(2), governs resident status for tuition purposes. If you do not qualify under one of the exceptions in the statute, you will be assessed nonresident tuition. In determining resident status for tuition purposes, standards are different from those used for voting, paying taxes, etc. In general, you must be a bona fide resident of Wisconsin for at least 12 months prior to enrollment for any semester or session in order to be eligible for in-state tuition. However, if you come to Wisconsin primarily for educational purposes, you do not automatically qualify as a Wisconsin resident even after living in Wisconsin for a year or more. The most common provisions of the statute under which you may qualify as a resident, or be able to pay at the resident rate, are:

1. Your parent(s) is a bona fide resident of Wisconsin for the year prior to your enrollment, and you graduated from a Wisconsin high school or were home-schooled or obtained a GED in Wisconsin.

2. You, your spouse, or someone who claims you as a tax dependent has moved to Wisconsin for full-time employment for a job relocation, or for new employment that was accepted before moving and before applying to this university, and which will continue full time with the same employer.

3. One of your parents is a bona fide resident of Wisconsin, and you are a tax dependent of one of your parents.

4. You are or were a member of the U.S. Armed Forces, or are the spouse or child of such a member. There are a number of exceptions for such individuals; please refer to the statute at the Web site listed below.

For the text of the statute, visit the Registrar’s Office Web site at www.registrar.wisc.edu. You may contact a Tuition Residency Counselor at 608–262–1355 or e-mail res4tuition@em.wisc.edu.

Minnesota Residents: Minnesotans may be eligible to participate in the Minnesota–Wisconsin Tuition Reciprocity Agreement. You must apply for certification through the Minnesota Office of Higher Education. Application materials are available online at www.getreadyforcollege.org. If you are approved for the program, you will be classified as a nonresident but assessed the approved reciprocity tuition rate.

SECTION I PERSONAL INFORMATION

APPLICATION CONTINUES ON NEXT PAGE

UNIVERSITY OF WISCONSIN–MADISONApplication for Undergraduate Admission 2011–12

Please read instructions before completing any part of this form.

•PLEASE PRINT OR TYPE •USE BLUE OR BLACK INK

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1 Name: Last (Family) _________________________________ First ___________________ Middle ___________________ 2 Previous Name(s) as used on high school/college records:

3 Social Security Number: – – 4 Sex: q Female q Male

5 Date of Birth: (mo/day/yr) _____ / _____ / _____

6 Place of Birth: City: __________________________State: __________ Country: ___________________

9 If not a U.S. citizen, check one:

q Refugee/Granted Political Asylum. Attach a copy of I-94.

q Resident Alien: Give Alien Registration Number: _______________ Attach a copy of both sides of Permanent Resident Card.

q Visa Holder: Give Visa Type (e.g., H4): ________________________

q I intend to request a Student Visa: q F1 q J1 q Other

8 Are you a U.S. citizen? q Yes q No If no, identify country of citizenship: ____________________________7 Race/Ethnicity: Please answer both a and ba. Ethnicity: Are you of Hispanic or Latino/a origin? q Yes q No (If yes, choose one or more from the following list.)

b. Race: Choose one or more from the list below.

q Cubanq Mexican, Mexican

American, or Chicano/a

q Puerto Ricanq Other Hispanic or Latino/a

q African American or Black q American Indian or Alaska Native (specify tribal affiliation)

___________________________

q Native Hawaiian/ Pacific Islanderq Cambodianq Hmong

q Laotianq Vietnamese q Other Asian q White

10 Have you and/or a parent or spouse served in the U.S. Military? (Check all that apply) q Self q Parent/Spouse q Neither

11 Has either of your parents earned a four-year college/university degree? q Yes q No

12 Which, if any, members of your family graduatedfrom UW–Madison? q Father q Mother q Grandparent q Sibling q Spouse

17 Name of campus you wish to enter:

UW–MADISON

18 Are you currently or have you previously attended UW–Madison?q Yes q No If yes, as: q Undergraduate q Graduate q Nondegree/SpecialIf yes, attendance dates: (mo/yr) From: _____ /_____ To: _____ /_____

19 Applying as: q New Freshman q Transfer q Reentry q Nondegree/Specialq Summer Only q Second Undergraduate Degree q Additional Major/Minor/

Certification

20 Semester/Term you plan to enter: (check one) q Fall (September–December) /Year _____ q Spring (January–May) /Year _____ q Summer (May–August) /Year _____ q Other/Year _____

21 I plan to attend the University:q Full-time q Part-time

22 Intended Major (see page 6): q Undecided

23 Academic School/College you wish to enter at the University(e.g., College of Letters & Science, Business, etc.; see page 6):

24 If you plan to teach, please check one:

q Early Childhood

q Elementary Education

q Secondary Education

25 Undergraduate Degree Sought: q B.A. q B.S. q Other _________________ q Unknown q None

27 Do you plan to apply for financial aid (loans, grants, work study)? q Yes q No

26 Possible career or professional plans:

28 Do you want to live on campus? q Yes q No

FOR OFFICE USE ONLY

q R q N

SECTION 2 ADDRESS INFORMATION

13 Permanent Home Address: (International students must provide a non-U.S. address.)

Street: ____________________________________________ City: _______________________________________

State: _______ Zip Code: – County (if Wisconsin): _______________________________ Country (if not U.S.): _________________________

Since (mo/yr): _____ /_____

Area Code and Phone Number: ( ) _______________________________

14 Mailing Address: (if different)

Street: __________________________________________ City: _______________________

State: _______ Zip Code: – Country (if not U.S.): _______________________________

Effective Dates (mo/day/yr): From: _____ /_____ /_____ To: ____ /_____ /_____

Area Code and Phone Number: ( ) _______________________________

15 Cell Phone Number: ( ) 16 E-mail Address:

SECTION 3 CAMPUS INFORMATION

Apply online at: apply.wisconsin.edu

SECTION 4 EDUCATIONAL BACKGROUND

34 Have you taken the ACT/SAT? q Yes q NoIf yes, dates: (mo/yr) q ACT ____ / ____q ACT ____ / ____

q SAT ____ / ____ q SAT ____ / ____

Name of School/College/University City/State From: (mo/yr) To: (mo/yr) Degree Earned/Year

36 List all institutions of higher education attended, both U.S. and foreign (even if you withdrew). Include name of college for courses taken in high school, colleges, universities, technical colleges, the institution you are currently attending, extension programs, etc., and any degree(s) earned. Attach an additional page if needed. Failure to list all institutions may result in disciplinary action, rescission of admission, and/or invalidation of credits or degrees earned.

31 ACT/ETS High School Code: (Obtain from H.S.)

33 Instead of a high school diploma, have you completed one of the following?

qGED qH.S. Equivalency Diploma

Issued by State of: ______________

Test date: (mo/yr) _____ / _____

29 High School or Home School of Graduation:

School________________________City________________________State________

30 Date of High School or Home School Graduation: (mo/yr) _____ / _____

32 Were you homeschooled at any point during grades 9-12? q Yes q No If yes, which grades? ______________

35 Are you scheduled to take the ACT/SAT? q Yes q No If yes, dates: (mo/yr) q ACT ____ / ____ q SAT ____ / ____

SECTION 5 (a) HIGH SCHOOL COURSES IN PROGRESS (If Applicable)

Semester/Term Department Name Course Title Number of Credits

If you are currently enrolled in high school, list courses to be completed during your senior year. Admission decisions are made with the expectation that all courses listed below will be successfully completed. Failure to complete all courses listed may result in rescission of admission. Notify the admissions office of any enrollment changes in the courses listed below. Students who are enrolled, or plan to enroll, in college courses while still in high school should complete both this section and Section 6a (College Courses in Progress).

Example: Fall Semester English American Authors .5

Example: Spring Semester Science Advanced Placement (AP) Chemistry .5

Example: Academic Year Mathematics Pre-Calculus 1

APPLICATION CONTINUES ON NEXT PAGE

SECTION 5 (b) ADDITIONAL HIGH SCHOOL INFORMATION (If Applicable)

Name of School City State Years of Attendance

If you plan to attend summer school, indicate name of school:

If you have attended any high school(s) other than the school from which you will graduate from, please include the name, city and state of each school and the years you attended each school.

Are you enrolled in the Wisconsin Youth Apprenticeship Program? q Yes q No If yes, identify program name:

Did you sign the Wisconsin Covenant Pledge?q Yes q No

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APPLICATION CONTINUES ON NEXT PAGE 3

SECTION 6 (a) COLLEGE COURSES IN PROGRESS (If Applicable)

List below the college courses in which you are currently enrolled. If you are officially registered for a future term(s), also list those courses. Attach an additional sheet if needed. Request an official transcript to be sent now and at the end of each term.

Name of College or University: _____________________________________________________

Course TitleSemester/Term& Year

Dept. Name Number of Credits

Example: Fall Semester 2009

CourseNumber

Psychology 101 Introduction to Psychology 3

Name of College or University: _____________________________________________________

Course TitleSemester/Term& Year

Dept. Name Number of Credits

Example: Spring Semester 2010

CourseNumber

Biology 201 Human Biology 4

SECTION 6 (b) ADDITIONAL COLLEGE INFORMATION

If you plan to attend summer school, indicate name of college/university: If you are attending a UW Colleges campus, Wisconsin Technical College, or other two-year/community college, will you have earned an associate degree prior to enrolling at UW–Madison? q Yes q No If yes, date expected (mo/yr): _____ / _____

SECTION 7 RESIDENCY AND PARENTAL INFORMATION FOR TUITION DETERMINATION (Must be completed by ALL applicants.)

38 Have you, your spouse or parents recently moved to Wisconsin to begin full-time employment, or do you expect to do so before the beginning of the term for which you are applying? qYes q No

40 Do you hold a valid Wisconsin driver’s license? q Yes Since (mo/yr): _____ /_____ qNo

42 Have you filed a Wisconsin state income (not property) tax return as a resident for the past two years? q Yes What years: _____ /_____ q No

44 Have you voted or registered to vote in Wisconsin? q Yes When? (mo/yr) _____ /_____ q No

37 Are you a legal Wisconsin resident and/or do you claim legal Wisconsin residence for tuition purposes? q Yes q No

39 I have lived continuously and only in Wisconsin since (mo/yr): _____ /_____

41 Have you registered a motor vehicle(s) only in Wisconsin? q Yes Since (mo/yr): _____ /_____ q No

43 I am listed as a dependent on income tax forms of: q Father q Mother q Spouse q Stepparent q Legal Guardian q Claim my own exemption since (yr): _____ q Other (specify) _______________

Street City State From: (mo/yr) To: (mo/yr)45 List all former addresses during the last two years. Attach an additional sheet if needed.

46 Check the appropriate box to indicate the relationship of the individuals described below and provide the required information. This section must be completed by ALL applicants (including dates).

Parent/Guardian 1:q Father q Mother q Stepparent q Legal Guardian Living? q Yes q No Parent/Guardian 2:q Father q Mother q Stepparent q Legal Guardian Living? q Yes q No

Name: Name:

Present Address: q Unknown Present Address: q Unknown

City/State/Zip City/State/Zip

Area Code and Phone Number: ( ) Area Code and Phone Number: ( )

Previous Home Address: q Unknown Previous Home Address: q Unknown

City/State/Zip City/State/Zip

Has he/she filed a Wisconsin state income (not property) Occupation: Has he/she filed a Wisconsin state income (not property) Occupation: tax return as a resident for the past two years? tax return as a resident for the past two years?

q Yes What years? ______ /______ q No q Yes What years? ______ /______ q No

Is he/she a U.S. citizen? q Yes q No Is he/she a U.S. citizen? q Yes q No If Permanent Resident, attach a copy of Permanent Resident Card (both sides). If Permanent Resident, attach a copy of Permanent Resident Card (both sides).

Where and when did he/she last vote or register to vote? (state) _______ (mo/yr) _____ /_____ Where and when did he/she last vote or register to vote? (state) _______ (mo/yr)______ /______

SECTION 7 RESIDENCY AND PARENTAL INFORMATION FOR TUITION DETERMINATION continued (Must be completed by ALL applicants.)

APPLICATION CONTINUES ON NEXT PAGE

47 List your employment history for the last two years. Attach an additional sheet if needed. Employer Occupation/Job Title City/State From (mo/yr): To (mo/yr): Hours per Week

SECTION 8 EMPLOYMENT AND ACTIVITIES

48 Please list below, in order of importance to you, your principal extracurricular, community and/or volunteer activities, as well as honors/awards earned. You may include involvement with school organizations, religious and service organizations, family obligations, employment, and/or participation in the arts, athletics, publications, etc. (Attach an additional page if needed.)

Activity Leadership Position, Honors and/or Awards Approximate Hours Number of Weeks Number of Years per Week per Year

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49 Briefly explain (in 50-100 words) how you decided which activity in Item #48 was the most important to you. (Attach an additional page if needed.)

Since (mo/yr):

_____ /_____

Since (mo/yr):

_____ /_____

Since (mo/yr):

_____ /_____

Since (mo/yr):

_____ /_____

I certify that the information in this application is true and complete to the best of my knowledge and I understand that inaccurate information may affect my enrollment, tuition or financial aid status. I agree to notify the admissions office, in writing, if there is a change to any of this information, including permanent home address. I also understand that if I have applied for financial assistance, information concerning the amount of financial aid I may be offered may be released to other agencies that may also be considering me for assistance. By filing this application, I authorize my high school to release a transcript of my high school record and any other pertinent information to the University of Wisconsin. I further authorize the University of Wisconsin to release my Social Security Number and date of birth to any UW Institution. If I enroll at UW–Madison, I will abide by its rules and regulations. This application and supporting documents become the property of the University of Wisconsin.

Applicant's Signature ________________________________________________________________________________________________________ Date _________________________________________________

For reentering students only: I hereby declare that my name has changed as shown in Item 2 (Section 1). By means of the above signature, I hereby authorize the University to change my records accordingly.

SECTION 10 APPLICANT'S SIGNATURE (To be valid, application must be signed and dated.)

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Submit your responses to both questions 50 and 51 on separate sheet(s) of paper. Include your full name and date of birth on each sheet and attach them to your application. 50 The University of Wisconsin values an educational environment that provides all members of the campus community with opportunities to grow and develop intellectually, personally, culturally and socially. In order

to give us a more complete picture of you as an individual, please tell us about the particular life experiences, perspectives, talents, commitments and/or interests you will bring to our campus. In other words, how will your presence enrich our community?

51 Tell us about your academic goals, circumstances that may have had an impact on your academic performance, and, in general, anything else you would like us to know in making an admission decision.

SECTION 9 STATEMENT(S)

College of Agricultural and Life Sciences

Agricultural and Applied EconomicsAgricultural Business ManagementAgronomyAnimal SciencesBiochemistryBiological Systems EngineeringBiologyCommunity and Environmental

SociologyDairy ScienceEntomologyFood ScienceForest ScienceGeneticsHorticultureIndividual MajorLandscape ArchitectureLife Sciences CommunicationMicrobiologyNutritional SciencesPlant PathologyPoultry ScienceRecreation Resources ManagementSoil ScienceWildlife Ecology

School of BusinessAccountingActuarial ScienceFinance, Investment, and BankingInformation SystemsInternational BusinessManagement and Human ResourcesMarketingOperations and Technology

ManagementReal Estate and Urban Land

EconomicsRisk Management and Insurance

School of Education ArtArt EducationBiologyChemistryChineseCommunicative DisordersDanceEarth ScienceEconomicsElementary EducationEnglishFrenchGeographyGermanHebrewHistoryIndividual MajorItalianJapaneseKinesiologyLatinMathematicsNatural SciencePhysicsPolishPolitical SciencePortugueseRehabilitation PsychologyRussianSocial StudiesSociologySpanishSpecial EducationTheatre and Drama

College of EngineeringBiomedical EngineeringChemical EngineeringCivil EngineeringComputer EngineeringElectrical EngineeringEngineering MechanicsEngineering PhysicsGeological EngineeringIndustrial EngineeringMaterials Science and EngineeringMechanical EngineeringNaval ScienceNuclear Engineering

School of Human Ecology Community and Nonprofit

LeadershipConsumer AffairsFamily, Consumer, and Community

EducationHuman Development and Family

StudiesIndividual MajorInterior DesignPersonal FinanceRetailingTextile and Apparel Design

College of Letters and ScienceAfrican Languages and LiteratureAfro-American StudiesAnthropologyApplied Math, Engineering, and

PhysicsArt HistoryAsian StudiesAstronomy-PhysicsAtmospheric and Oceanic SciencesBiochemistryBiological Aspects of ConservationBiologyBotanyCartography and Geographic

Information SystemsChemistryChineseClassical HumanitiesClassicsCommunication ArtsCommunicative DisordersComparative LiteratureComputer SciencesEconomicsEnglishFrenchGender and Women’s StudiesGeographyGeology and GeophysicsGermanHebrewHistoryHistory and History of Science,

Medicine, and TechnologyHistory of Science, Medicine, and

TechnologyIndividual MajorInternational StudiesItalianJapaneseJewish StudiesJournalismLanguages and Cultures of AsiaLatin

Latin American, Caribbean, and Iberian Studies

Legal StudiesLinguisticsMathematicsMedical Microbiology and

ImmunologyMedical ScienceMicrobiologyMolecular BiologyMusicPhilosophyPhysicsPolishPolitical SciencePortuguesePsychologyReligious StudiesRussianScandinavian StudiesSocial WelfareSocial WorkSociologySpanishStatisticsTheatre and DramaZoology

School of NursingNursing

School of PharmacyPharmacology and Toxicology

UW–Madison also offers more than 45 certificates, which are similar to minors. For more information, visit www.wisc.edu/academics/majors.php.

Undergraduate Majors

The University of Wisconsin–Madison does not discriminate in its employment practices and programs and activities on a variety of bases including: race, color, national origin, sex, disability or age. For information on other covered bases, and the names of the Title IX and Americans with Disabilities Act coordinators, contact the Office for Equity and Diversity at 179A Bascom Hall, Madison WI 53706, 608-263-2378, WTRS 7-1-1; Web site: www.oed.wisc.edu. Produced for the Office of Admissions by University Communications. Photos by University Communications. August 2010

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