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.

______________________________________ 

_____________ 


Please identify alternate courses in case your first choice is not available or approved:

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