STUDENT REGISTRATION FORM

    IMPORTANT NOTE: Prior to completing this registration form, please take a moment to review the Graduate School Preview Day Agenda and the list of graduate programs offered at the University of Maryland College Park (UMCP).

    UMCP does not offer graduate programs in Dentistry, Law, Medicine, Nursing, Pharmacy or Social Work.

    PERSONAL INFORMATION

  1. First Name:

  2. Middle Initial:

  3. Last Name:

  4. Email Address:

  5. Email Address: Please confirm your email address.

  6. Home Phone Number: (123-456-7890)

  7. Mobile Phone Number: (123-456-7890)

  8. Current Mailing Address: Please include your Street, Apartment/Unit Number, City, State and Zip Code.

  9. Gender:
    1. Male
    2. Female

  10. Date of Birth:(ie. 01/23/1999)

  11. Race/Ethnicity: (Optional)
    1. American Indian/Alaskan Native
    2. African American/Black
    3. Asian Pacific American
    4. Hispanic/Latina(o)
    5. Caucasian/White
    6. Other

  12. Citizenship Status: (Optional)
    1. United States Citizen
    2. U.S. Permanent Resident/Refugee
    3. Foreign National (non-U.S.)
    4. Other

  13. Emergency Contact Name:

  14. Emergency Contact Phone Number:

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Questions, Comments and Concerns: Please contact Office of Graduate Recruitment, Retention and Diversity via email at recruitment@gradschool.umd.edu