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. Please do not submit this application multiple times.

Note: Be aware that your computer’s auto-fill functionality can potentially populate fields on the application with incorrect data. Please ensure you are aware of any data being auto-filled and check for accuracy.

* 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

* Country of Citizenship

* County of Birth

Optional: Please enter your Social Security Number (SSN) below.

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