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A. Legal Name

If you prefer we use a different first or middle name than your legal name, please enter them below.
B. Contact Information

Please enter at least one phone number.

C. Other Demographics

The following questions relate to racial and ethnic identity. Please respond to both questions.

D. Campus, Semester and Program Choice

E. Education-High School and Post-Secondary

Type the first few letters of your high school's name. If your high school doesn't appear, choose Other High School.

F. Signature
I certify that the information on this application is true and complete to the best of my knowledge. I understand that typing my name in the box provided below is the equivalent of placing my signature on a document.

Mid-State Technical College does not discriminate on the basis of race, color, national origin, sex, disability or age in its program, activity, or employment.

The following person has been designated to handle inquiries regarding the nondiscrimination policies:
Vice President – Human Resources:
500 32nd Street N
Wisconsin Rapids, WI 54494


G. Constant Values