Youth Options Program/High School Special Student Application Form University of Wisconsin-Stevens Point
Print and complete this application if you are currently enrolled in high school and wish to enroll in undergraduate courses at UW‑Stevens Point. Please print and carefully read the General Information and Procedures before completing any part of this form. Completed applications should be sent to:
Admissions Office, Park Student Services Center UW‑Stevens Point Stevens Point, WI 54481 A separate form must be completed for each term you wish to enroll at UW‑Stevens Point.
Section 1: To Be Completed By The Student Applicant
Desired Term of Enrollment: (Please check one) __ Fall, 20____ - ______ Spring, 20____ - ____ __ Summer session 20____ Name:__________________________________________________________________________ LastFirstMiddle Home Address: __________________________________________________________________________ Street City _____________________________________________________________________________ County State Zip Code Social Security #:_______________________________ Telephone #: ( ) __________________ Name of High School:__________________________________________________
During the semester enrolled, I will be a high school (check one): ______ Junior ______ Senior
The course(s) I wish to take at UWSP will be taken for (check one): ______ College credit only ______ Both high school and college credit
I have previously completed college courses: Yes _______ No ______ If yes, where did you complete the course(s)? _________________________________
Total number of credits you wish to take at UWSP: ____________
I wish to take the following course(s) at UWSP (attach additional page if needed):
Course Number and Title
# of Credits
1.
______________________________________
_____________
2.
3.
Father's Name:_______________________________________ Father's Address:_____________________________________ City/State/Zip:________________________________________ Since: (mo/yr)________________________________________
Mother's Name:______________________________________ Mother's Address:____________________________________ City/State/Zip:________________________________________ Since: (mo/yr)________________________________________
I have lived continuously and only in Wisconsin since: (mo/yr) ___________________________
List former addresses, if any, during the last two years: Street City State From: (mo/yr) To: (mo/yr) _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________
I certify that the information in this application is true and complete to the best of my knowledge. I understand that inaccurate information may affect my eligibility to enroll at UW‑Stevens Point. If I enroll at the University, I will abide by its rules and regulations. I also understand that courses taken at the University of Wisconsin-Stevens Point will become part of my permanent university record and may affect my subsequent eligibility for admission to post-secondary institutions. I authorize the University of Wisconsin-Stevens Point to provide information about my course registration, grades and attendance to my high school, school district administrator and school board. ______________________________________ _______________________________________ Applicant’s Signature/Date Parent’s Signature/Date
Section 2: To Be Completed By The High School Guidance Counselor or Principal
This student has the permission of the high school administration to enroll in the above listed courses at the University of Wisconsin-Stevens Point. I recommend this student as being capable of study at UW-Stevens Point. I have enclosed a copy of the student’s high school transcript with this application.
__________________________________ ___________________________________________ Student’s Rank/Class Size Signature of Guidance Counselor or Principal/Date ________________________________ _______________________________________ Student’s ACT or SAT Score (if available) Name of High School PLEASE ATTACH STUDENT’S _______________________________________ OFFICIAL TRANSCRIPT AND ACT Address of High School OR SAT SCORE REPORT (IF AVAILABLE.) _______________________________________ Phone Number of High School
________________________________ _______________________________________Address of School District Billing Office Phone Number of School District Billing Office
Section 3: To Be Completed By The District Administrator of the School District
This section should ONLY be completed for those students seeking high school credit and for which the school district will be responsible for payment of fees incurred. This student has the permission of the School Board of the ________________________________ School District to enroll in the course(s) listed above at the University of Wisconsin-Stevens Point. The student will be granted high school credit if (s)he satisfactorily completes the course(s). The school district understands its responsibility for payment of fees incurred as a result of this student’s registration for the course(s). ________________________________________________ _______________________ Signature of District Administrator Date
This student has been approved to enroll in _______ credits.
Section 4: For UW-Stevens Point Admissions Office Use Only
Application: Approved __________ Denied __________ # of Credits Approved __________ _______________________________________ Signature of Admissions Official/Date