Application for Undergraduate Admission — Independent Study Program

If you prefer to mail or fax your application, you may download an application (pdf format).

This form is for application to the Independent Study Program.
 It should not be used for application to any other Upper Iowa University program or location.

Note:  Upper Iowa University accepts MasterCard, VISA and Discover credit cards for online payments.

Step 1 of 2:  Complete the Form.

* indicates a required item

Title or Rank Mailing Address (Number, Street, or P.O. Box)*
First (Given) Name* City*
Middle Name* State*
Last (Family) Name* ZIP Code*
Maiden Name Home Phone*
Social Security Number* E-mail Address*
Date of Birth* Fax Number
Gender Female Male Anticipated Start Date*
Are You a U. S. Citizen? Yes No     If no, state country of citizenship
How did you learn about Upper Iowa University?

if you choose "other," please describe:
 ARTICULATION PARTNERS
If you were referred to UIU by one of our articulation partners, note the school here:

Employer*

Job Title*

Full Time Part Time

Work Address*

Work Phone*

 

Military Status (Check one, if applicable)

None
Active Duty
Military Family Member
Retired Military (Veteran)
Reserve
National Guard
Civilian Employee of DOD

Service Branch

Please indicate interest:*
Transient (nondegree seeking)
Associate of Arts, Liberal Arts
Associate of Arts, General Business
Bachelor of Science

Ethnicity (optional)

Decline to answer
White Non_Hispanic
Black Non_Hispanic
Hispanic
Asian, Pacific Islander
American Indian, Alaskan Native
Multi_Ethnic

Bachelor of Science, Majors in:
Accounting
Business Administration
Criminal Justice
Emergency and Disaster Management
Finance
Health Services Administration
Human Resources Management
Human Services
Interdisciplinary Studies
Management
Marketing
Psychology
Public Administration, general
Public Administration, law enforcement
Public Administration, fire science
Social Science
Technology & Information Management

Certificates in:
Emergency and Disaster Mgmt
Human Resources Management
Marketing
Organizational Communications
Organizational Leadership

Minors in: (Optional)
Accounting
Criminal Justice
Emergency and Disaster Management
Finance
General Business
Health Services Administration
Human Resources Management
Management
Marketing
Psychology
Public Administration
Sociology
Technology & Information Management

Payment Options (check if you are planning to use any of the following)
   Financial Aid     Tuition Assistance     Veterans Benefits     Other

Do you plan to request a Servicemembers Opportunity College (SOC) agreement?
(required if active duty Army, Coast Guard, Marine Corps, National Guard, or Navy)
Yes No

Previous Education*

High School  Address  Graduation Date

College/University/
Technical or Vocational Schools*
Dates of
Attendance
From / To
Credit
Hours
*List all institutions previously attended. Failure to fully disclose this information may result in denial of admission or dismissal from the University.

 
Credit by Examination CLEP   DSST   PEP     Other
Transfer*:  (choice must be made before first enrollment)
         Grades "C" and above
         All Grades
Payment of the $50 application fee is required
unless you belong to one of these categories
(please check category):
Associate degree from UIU
Active Duty Military Member
Spouse of Active Duty Military Member
Employee of UIU
Graduate or Employee of
        Articulation Partner
        (must be listed above)
For payment of $50 application fee,
please charge my:
Name on Card:
Credit Card Number:
- - -
Expiration Month:
Expiration Year:
Card Security Code:
What is this?     

Do you have any other comments or questions?  If so, please enter them here:

I have received and read the materials on the Upper Iowa University program and fully understand the contents.  I CERTIFY that the information on this application is accurate and true.  I understand the University will hold all information in strict confidence.

      

Card Security Code:

The Card Security Code (CSC) is a 3- or 4-digit number printed on your credit card. It provides added security when you use your card on the Internet or over the phone. The number appears only on the card itself, not on charge receipts or statements. You are indicating by providing the CSC that you have the card in your possession and are not using a stolen credit card number.

Locating the Card Security Code for Visa and MasterCards:

Turn the card over and look at the signature box. You will find either the entire 16-digit credit card number or just the last 4 digits, followed by the 3-digit CSC.

Back

Disclaimer

This Upper Iowa University Catalog contains information regarding fees, curricula, and related policies and procedures. Every effort has been made to make the catalog accurate as of the day of publication. However, Upper Iowa University reserves the right to change policies or revise the information contained in this catalog. All such changes will be effective at the time deemed appropriate by the proper institutional authorities and may apply to enrolled as well as prospective students.

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