UMD College in the Schools Student Participation Form 2015/2016
Instructions:
(1) Download this form and save it as a Word file.
(2) Enter HS year: 11 for juniors, 12 for seniors fall
2015.
(3) email form(s) as an attachment to
Check Term:
Fall 2015___ Spring 2016___
High School Name:
High School Contact:
UMD course name & number:
Contact email:
Contact’s Phone #:
UMD Office Use:
Contract #:
Comments:
Date Recd.
Date to Reg.:
Date Processing Completed:
bperushe@d.umn.edu
Use a separate form for each class and section; email to
bperushe@d.umn.edu.
Questions, call Barb Perushek at 218/726-6938.
HS
Year
1
2
3
4
5
6
7
8
9
10
11
12
13
14
Cum Last Name
GPA
First Name
M.I.
Address
City
Zip
Birthdate M/F
MARSS #
Phone #
HS
Year
CUM Last Name
GPA
First Name
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
N:\CAS\Sit\common\CITS\CITS Essential Docs\CITS Web Forms\Forms
M.I.
Address
City
Zip
Birthdate M/F
MARSS #
Phone