Research Registry Enrollment

The following information will allow the K-12 Registry to more effectively identify the studies for which a member of your family may qualify. All information provided is kept confidential.

Your name:

Parent/Guardian 1

First name:
Last name:
Street:
City:
State:
ZIP:

Phone (at least one)
Home:
Work:
Cell:

Email:

Race: Asian
Black
Native American
Other
Pacific Islander
White

Ethnicity:
Education (years):

Parent/Guardian 2

First name:
Last name:
Street:
City:
State:
ZIP:
Phone (at least one)
Home:
Work:
Cell:

Email:

Race: Asian
Black
Native American
Other
Pacific Islander
White

Ethnicity:
Education (years):

How did you hear about us?

University of Wisconsin-MadisonK-12 Registry

University of Wisconsin-Madison
K-12 Registry