University of Wisconsin-Milwaukee
Assignment 4-5
UWM Information Request Form
Adrian Flores, Assignment 4-5
Enter your information in the form below:
First Name:
Last Name:
Email Address:
Phone:
Birthdate:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
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4
5
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31
2005
2004
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2002
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1990
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1988
1987
1986
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1984
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1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
Are you a student at UWM?
Yes
No
What areas of study are you interested in?
Information Technology
History
Math
Comments: