UCCS Academic Outreach Application

Academic Outreach/Extended Studies programs provide non-traditional educational opportunities for high school students, professionals and life-long learners.

This application will take approximately 15-20 minutes to complete. Please make sure you have adequate time to complete this application at one time. If you do not complete it at one time, you will have to start the application from the beginning again.

*Legal First Name

Legal Middle Name

*Legal Last Name

Preferred First Name (if different from your Legal First Name)

Please make sure to enter any former (previous) last names that appear on your academic records - this is very important because if documents are being sent to UCCS under a different name, UCCS will need to have that name to match the document to your application file.
Former Last Name

Former Last Name 2

*Email Address

*Main Contact Phone Number:

*Address Line 1

Address Line 2

*City

*State

*Zip Code

*Date of Birth

Gender/Sex Assigned at Birth

Are you Hispanic, Chicano, Mexican, Latino, Cuban, Puerto Rican, South or Central American, or Spanish origin?

Yes No

Please select one or more racial categories to describe yourself:

*Citizenship Status

Please enter your Social Security Number (SSN) below. If you do not have a SSN, you do not need to enter anything in the Social Security Number field (it is not required). This field refers to U.S. citizens only. However, if you will be applying for financial aid, please make sure they know you do not have a SSN.

Please click on Save & Next below to continue the application.