Name:    Phone:
Phonetical Spelling of Last Name (Ex.-Baeseman = Baze-men):
Local Address:

Family's Name: Phone:
Address: 

Expected Date of Graduation:    Overall G.P.A.:
Major(s):    Minor(s):

1) Please indicate your involvements over this past academic year (including employment and organization involvement).
   Organization/Office/Team    |    #Hours/Week    |    Your Position 

2) Please list the activities/events/work/team experiences you participated in while involved with the above listed involvements.

3) List any conferences or training workshops you participated in this past year.

4) List any other campus or community volunteer activities you have been involved in, other than those already listed.

5) Using specific examples please indicate how you have personally grown and developed through your experiences at UWSP during the past year.

If you have questions or comments, please contact the Campus Activities and Recreation Office at 346-4343.