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Davis United World College Scholars PROGRAM Returning Scholar Registration Form Please save a copy to your computer prior to completing this form. Class of 20 XX College/University Gender Full Name LAST NAME Nationality FIRST NAME M F MI UWC Attended Current School Address Phone Email Permanent Home Address What is your intended major eld s of study Please list courses completed in previous academic year grades optional. Course Name Grade Please list activities or services that have been most signi cant in your experience over the past year. I attest that the information provided is accurate and complete and I recognize that being a Davis UWC Scholar is contingent upon submission of requested data over the four years of my undergraduate degree studies. I further consent to the use of this information in print and electronic form for Davis UWC Scholars program purposes. YOUR SIGNATURE DATE DD/MM/YY Return the completed form as directed by your college DUWCSP liason* 7/2015. Course Name Grade Please list activities or services that have been most signi cant in your experience over the past year. I attest that the information provided is accurate and complete and I recognize that being a Davis UWC Scholar is contingent upon submission of requested data over the four years of my undergraduate degree studies. I attest that the information provided is accurate and complete and I recognize that being a Davis UWC Scholar is contingent upon submission of requested data over the four years of my undergraduate degree studies. I further consent to the use of this information in print and electronic form for Davis UWC Scholars program purposes. I further consent to the use of this information in print and electronic form for Davis UWC Scholars program purposes. YOUR SIGNATURE DATE DD/MM/YY Return the completed form as directed by your college DUWCSP liason* 7/2015. Course Name Grade Please list activities or services that have been most signi cant in your experience over the past year. I attest that the information provided is accurate and complete and I recognize that being a Davis UWC Scholar is contingent upon submission of requested data over the four years of my undergraduate degree studies. I further consent to the use of this information in print and electronic form for Davis UWC Scholars program purposes. I attest that the information provided is accurate and complete and I recognize that being a Davis UWC Scholar is contingent upon submission of requested data over the four years of my undergraduate degree studies. I further consent to the use of this information in print and electronic form for Davis UWC Scholars program purposes. YOUR SIGNATURE DATE DD/MM/YY Return the completed form as directed by your college DUWCSP liason* 7/2015.

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