| PERSONAL INFORMATION |
| Gender: |
Female Male |
| First Name: |
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| Last Name: |
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| Address 1: |
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| Address 2: |
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City:
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ZIP / Postal Code:
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| Country: |
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| Phone number: |
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| E-mail address: |
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| Preferred mode of communication: |
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| ACADEMIC INFORMATION |
| Are you or will you be a: |
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| Expected enrollment term: |
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| Expected enrollment year: |
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| High school you are attending/attended: |
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| Location of high school (city, state): |
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| High school graduation year: |
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| Have you taken the ACT/SAT? |
Yes No |
| ACT Composite Score: |
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| SAT Verbal: |
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| SAT Math: |
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| High school GPA: |
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| FOR TRANSFER STUDENTS ONLY |
College or university attended/attending:
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Location of college/university (city and state):
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Dates of attendance:
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| FOR INTERNATIONAL STUDENTS ONLY |
Have you taken the TOEFL?
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Yes No |
What was your TOEFL score?
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| PERSONAL INTERESTS |
| Possible major at UIU: |
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| Please send me more information about: |
Applying to UIU
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Visiting UIU
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Scholarship/Financial Aid
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I would like to speak to my admissions counselor
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| I learned about Upper Iowa University from: |
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