Request or Update Information

Information Request or Update

Complete the form below to receive information from Parkside.

International students should use the International Info Request form.

Returning users can update their information by logging in, updating any fields on this screen, and submitting.

Note: Fields marked with an asterisk (*) are required.

* Note: To request information and/or register for an event, fill out the forms below. You will be able to log back in to update your information.All fields marked with an asterisk (*) are required!!!!!!

STUDENT INFORMATION

First Name:

Please enter a valid First Name

Last Name:

Please enter a valid Last Name

Username:

Password (at least 7 characters):

Email:

CONTACT INFORMATION

Street Address:

Unit#:

City:

State:

Country:

ZIP Code:

Primary Phone:

Other Phone:

HIGH SCHOOL/COLLEGE DETAILS

High School:

High School Finder

Clear

High School Graduation Year:

Most recent college of attendance, if any:

College Finder

Clear

EDUCATIONAL ASPIRATIONS

Entering as:

Projected Start Term:

Major/Interest Area:

Major/Interest Area 2 (optional):

PERSONAL DETAILS

Date of Birth (MM/DD/YYYY):

Race/Ethnicity (Optional, select all that apply):

African American or Black
American Indian, Native American, or Alaska Native
Asian
Latino(a) or Hispanic
Native Hawaiian or Pacific Islander
White
Other Race

D I S C L A I M E R: The data presented on this page is confidential.

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900 Wood Road • P.O. Box 2000 • Kenosha, WI 53141-2000 P 262-595-2345