International Alumni Information Update

All information collected is for use only by the University of Wisconsin-Madison, the Wisconsin Alumni Association and our affiliates. Please review our privacy policy if you have any questions.

First name:
Family name:
Family name at graduation (if different):
Date of Birth:
Gender:	Female Male
Home Information
Address 1:
Address 2:
Apt #:
City:
State/Province:
Country:
Postal Code :
Phone number :
Fax number :
Cell phone number:
E-mail address :
Years Attended :
	Purpose (Select all that apply)
	Undergraduate Student
	Graduate Student
	Exchange Student
	Short-term course student
	Researcher
	Post doctorate
	Visiting scholar
	Visiting faculty
Name of advisor, major professor or key university contact:
Did you get a UW Degree?	Yes No
If no, with which school or college were you affiliated?
If yes, please answer the following questions:
	Degree(s) earned
	Bachelors
	Masters
	PhD
Year(s) received:
School or College:
Major(s):
Business Information
Occupation:
Position:
Company/Organization:
Business Address 1:
Business Address 2:
Business City:
Business State/Province:
Business Country:
Business Postal Code :
Business Phone number :
Business Fax number :

Yes, I would like to receive mailings and publications from UW Madison

Yes, I would like to receive UW International, the Wisconsin Alumni Association's newsletter for alumni living outside the United States: