URGO Information Form

URGO Registration Form:

First Name:
Last Name :
Email:
Phone Number:
Major(s):
Minor(s):
Advisor:
Class Standing: Freshman Sophomore Junior Senior
Anticipated Grad Date:
Alum? Yes No
Student Type: Weekend College Undergraduate Day
Cumulative GPA:
Ethnicity (optional):
Graduate/professional area of interest:
How did you hear about this office?
Are you a U.S. Citizen or permanent resident? Yes No
Did either parent/guardian graduate from a four-year college? Yes No
Do you think you might qualify as a low-income student?  Yes No

Total Number of Exemptions Claimed:
(Number of people in your immediate household)

Taxable Income Less Than:
2006  Federal Tax

1

15,315

2

20,535

3

25,755

4

30,975

5

36,195

I would like additional information about:
(check all that apply)
On-campus research opportunities LSAT Prep
Off-campus summer research opportunities Law school admissions
Graduate school admissions Medical/Healthcare admissions
GRE prep MBA admissions
Undergraduate scholarships/fellowships Graduate scholarships/fellowships

Contact:  Dixie Shafer, Director, Undergraduate Research and Graduate Opportunity, x1447, shafer@augsburg.edu

Copyright 2006. Augsburg College. All rights reserved.