Step 1 of 6: Name and Contact Information

Required fields are marked with an asterisk (*)

Title:
Mr.  
Ms.  
Rev.  
Sr.  
Br.  
Dr.  
Rabbi  
First Name*:


Full Middle Name:


Last Name* (add Jr., etc.):


Previous Name (if any):

Address 1 - Number, Street or P.O. Box*:


Address 2 (use if necessary):


City*:


Country of Current Residence*:


U.S. State:


Zip/Postal Code*:



Home Phone*:


Cell Phone:


Work Phone:


E-mail Address*:


Questions about this form?

phone: (414) 288-3153
toll-free: (800) 793-6450, extension 2
fax: (414) 288-3298
e-mail: mcps@marquette.edu

College office hours:
Monday, 8:00 a.m. to 4:30 p.m.
Tuesday - Thursday, 8:00 a.m. to 5:30 p.m.
Friday, 8:00 a.m. to 4:30 p.m.
Saturday, 7:30 a.m. to 1:00 p.m.