Data IC Form

Part B - Organization & Accreditation

1.	What is your institutional control or affiliation?
	Public - Specify
	Primary control	Secondary control (if applicable)
	STATE
	Private for-profit
	Private not-for-profit independent (no religious affiliation)
	Private not-for-profit religious affiliation - Specify


2.	What award levels are offered by your institution? (One academic year equals 30 semester credit hours or its equivalent, or 900 contact or clock hours.) [Check all that apply]

	Award Level	BELOW THE BACCALAUREATE:
	1	Postsecondary award, certificate, or diploma of less than one academic year (less than 900 contact or clock hours)

	2	Postsecondary award, certificate, or diploma of at least one but less than two academic years (at least 900 but less than 1800 contact or clock hours)

	3	Associate’s degree

	4	Postsecondary award, certificate, or diploma of at least two but less than four academic years (at least 1800 contact or clock hours)


		BACCALAUREATE AND ABOVE:
	5	Bachelor's degree or equivalent
	6	Postbaccalaureate certificate
	7	Master’s degree
	8	Post-master’s certificate
	9	Doctor’s degree
	10	First-professional degree
	11	First-professional certificate (Post-degree)
	12	Other; please specify in the Caveats box

CAVEATS


Please verify the information below, and update as necessary. Asterisks () indicate information which is required.**

Institution Name	UNIVERSITY OF WISCONSIN EXTENSION

Physical Location:
Street Address	432 N LAKE ST_____________________________________
City	MADISON________ **	State	WI **
Zip Code	53706 - ____ **

Enter Official Name Change Here	__________________________________________________

Mailing Address (If different from Physical Location):
Street Address	__________________________________________________
City	_______________	State	SELECT..
Zip Code	_____ - ____

Web Address	http:// uwex.edu/____________________________________
Employer ID No. (EIN)	391805960	OPEID	003895A3

Chief Administrator:
Name	KEVIN P. REILLY___________________________________
Title	CHANCELLOR__________

Telephone Numbers:
General Information	608 - 262 - 6151 Ext. _____ **
Admissions Office	___ - ___ - ____ Ext. _____
Financial Aid Office	___ - ___ - ____ Ext. _____

1.	Which of the following types of instruction/programs are offered by your institution?
	[Check one or more]

	Occupational, may lead to a certificate, degree, or other formal award
	Academic, leading to a certificate, degree, or diploma
	Continuing professional (postbaccalaureate only)
	Recreational or avocational (leisure) programs
	Adult basic or remedial instruction or high school equivalency
	Secondary (high school)