Visit Event Registration

Wednesday, July 15, 2020 - Health Sciences at Iowa Virtual Information Session (4:00 P.M.)

* Fields with a red asterisk (*) are required

Student Information

We ask that each student register individually

*Student Email Address

*Student First Name

Student Middle Name

*Student Last Name

*Student Birth Date (mm/dd/yyyy)

Current Address and Phone

*Country

*Please enter country name:

*Address

*City

*State

Province:

*Postal Code (Zip)

*Primary Phone:

This is a cell phone

Citizenship and Ethnicity/Race Information

*Country of Citizenship

Are you Hispanic/Latino(a)?

Yes

What race do you consider yourself to be? (indicate one or more)
See definitions

Alaskan Native/American Indian

Tribal affiliation:

African American or Black

Native Hawaiian or Other Pacific Islander

Asian

White

School Information

High School

*Graduation Year

*Planned College Enrollment Session

GPA

Scale

ACT Composite Score

SAT Reading/Writing Score

SAT Math Score

Academic Area of Interest

*Area of Interest 1

Area of Interest 2 (Optional)

Area of Interest 3 (Optional)

Parent/Legal Guardian Information

Parent/Guardian Email Address

Parent/Guardian First Name

Parent/Guardian Last Name

Relationship

Visit Guest Information

* One Student is registered to attend this event. Please select the number of additional registered guests who will be attending.

Please explain if anyone in your party will require special assistance

Individuals with disabilities are encouraged to attend all University of Iowa-sponsored events. If you are a person with a disability who requires an accommodation in order to participate in this program, please contact the Admission Visitors Center in advance at 319-335-1566.

I acknowledge and understand:

Health and Safety Guidelines
Campus visits will be limited in size and all visitors will agree to safety guidelines.
If you are not fully vaccinated, you are strongly encouraged to continue wearing a mask and physically distancing on campus. If you are fully vaccinated, you should feel comfortable continuing to wear a mask if you choose. Whether or not to wear a mask is a personal decision and is often unrelated to a person's vaccination status. Do not harass a student, visitor, or fellow employee for choosing to wear, or not wear, a mask.
Masks continue to be required in health care settings and where required by state or federal guidelines (e.g., passengers on CAMBUS).

* I have read and understand the above required social distancing and Covid-19 policies.