Transtions College Prep Workshop Registration

Workshop Registration
* Required Field
First Name*
 
Middle Name
 
Last Name*
 
Gender*
 
Male    Female

Birthdate*

  
/ / (MM/DD/YYYY)
Street Address *
 
City*
 
State*
 
Zip Code*
 
Phone Number*
 
E-mail Address*
 
High School*
 
High School Graduation Date*
 
/ (MM/YYYY)
If Dual Enrolled, Name of College
 
Area(s) of Academic Interest
 
Total Number Attending (student+guests)*
 
     

Please submit the form only once.

If you have any questions, please call the Office of Admissions and Orientation at 313-593-5100.
University of Michigan-Dearborn
4901 Evergreen Road     Dearborn, MI 48128     www.umd.umich.edu