By: Fall Springsummer

Return August 1 December 1April 15

By: Fall SpringSummer

Year

Fall

Spring

Summer

Semester Information

Please fill this form out in its entirety and email back to. It is an interactive form that will give you the ability to check boxes, pull down menus, and add text. Use the tab key to jump to each text field.

Contact Information

Student Status

First Year

Second Year

Dissertator

Internship

None Above

Name: FirstMiddleLastID:

Email: @wisc.edu

Office: NumberBuildingPhone:

Local: Street, City, State, ZipPhone:

Funding Information (Complete what is pertinent to you.)

If multiple appointments, select both appointments and enter percentages for selections in order from left to right.

Completing this semester?

Master’s

Major Prelim

Specialty Prelim

Final Oral Exam

PA RA TALecturer

Percent Appointment:

Appointment Department: Psych./Ed. Psych./Waisman/ETC

Emotion TraineeLanguage Trainee

FellowshipSource: Funding: 100%

Area:

Major Professor:

Last Name

Has any of the above information changed since last semester?

Yes No

Self-supporting Other:

Coursework

DEPT/COURSE #Course TitleCredits Fulfills:

Total Credits:

Additional Information (Leave blank if none.)

This information is needed for tuition remission, third party deferral, student progress reports, compiling the student directory, initiating the warrant process, and is used by your major professor and department as a whole. Return your information on time.