UW Flexible Option Re-Entry Application Applicant Information Name* First Last Date of Birth* MM slash DD slash YYYY Campus ID# Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Veteran* Yes No Education Background Information Currently attending:* UW-Milwaukee 2-year UW Campus Date of previous UW-Flexible Option attendance:* Previous schools/universities attended:* Desired Program & Subscription Period Program*Associate of Arts & ScienceBusiness & Technical Communications CertificateDiagnostic ImagingGeneral Education, Liberal ArtsInformation Science & TechnologyHealth SciencesNursing (RN to BSN)Project ManagementSales CertificateMonth/Year* Brief Application Statement Please provide a brief application statement: * 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 effect my enrollment, tuition or financial aid status. 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. If I enroll at this University, I will abide by its rules and regulations. This application and supporting documents become the property of the University of Wisconsin System. Initials* Δ