DSST Registration Form

Part 1 of 3

NOTE: Fields marked with a star * are required.

*Choose one of the following:

I am an IWU Student

I am not an IWU Student

*First Name: *Last Name:

Gender: MaleFemale Birthdate:

*Last 4 digits of Social Security Number:

*Email:

*Daytime Phone: Ext:

*Address:

*City:

*State: *Zip: