UIC Office of Continuing Education

Create Student Profile

Fields marked with an * are required.

First Name : *
Middle Initial :
Last Name : *
Previous Name :
Gender :	Female Male
UIN : (Only for UIC students)
E-mail Address : *
Address Line 1 : *
Address Line 2 :
City : *
State : *
Province :
Zip Code : *
Country :*
Day Phone :* ###-###-####
Evening Phone : ###-###-####
Mobile Phone : ###-###-####
Fax : ###-###-####
Occupation/Title :
Employer :
Highest Educational Level :
Racial/Ethnic Information (optional): Your response to the following is voluntary and will not affect your application. For data collection purposes, check only one box that indicates race/ethnicity you identify with most.
Which category describes your race/ethnicity?
If you selected "Other Hispanic", please specify your race/ethnicity :