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PERSONAL INFORMATION

Gender: Female Male

*First Name:

*Last Name:

*Address 1:

Address 2:

*City:

State / Province: Please select . . . Alabama Alaska Alberta Arizona Arkansas British Columbia California Colorado Connecticut District of Columbia Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana New Brunswick North Carolina North Dakota Nebraska Newfoundland New Hampshire New Jersey New Mexico New York North West Territories Nova Scotia Nevada Ohio Oklahoma Ontario Oregon Pennsylvania Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Wisconsin West Virginia Wyoming Yukon

*ZIP / Postal Code:

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Preferred mode of communication: Please select . . . Phone E-mail Mail IM Cell Phone

ACADEMIC INFORMATION

Are you or will you be a: Please select . . . Freshman Transfer Returning UIU Student International Student Master's of Education Nursing Student

Expected enrollment term: Please select . . . Fall Spring

Expected enrollment year: Please select . . . 2008 2009 2010 2011 2012 2013 2014

High school you are attending/attended:

Location of high school (city, state):

High school graduation year:

Have you taken the ACT/SAT? Yes No

ACT Composite Score:

SAT Verbal:

SAT Math:

High school GPA:

FOR TRANSFER STUDENTS ONLY

College or university attended/attending:

Location of college/university:
(city and state)

Dates of attendance:

FOR INTERNATIONAL STUDENTS ONLY

Have you taken the TOEFL? Yes No

What was your TOEFL score?

PERSONAL INTERESTS

Possible major at UIU: Please select . . . Accounting Agricultural Business Applied Plant Science Art Athletic Training Biology Business Administration Chemistry Communications Conservation Management Criminology Elementary Education English Environmental Science Financial Management Fitness/Wellness Forensic Science General Business Graphic Design Health Care Administration Human Services Industrial Technology Information Technology International Business Life Science Management Management Information Systems Marketing Mathematics Mortuary Science Nursing (RN-BSN) Physical Education Prekindergarten-Grade 3 Psychology Recreation Science Social Science Sociology Sports Science

Please send me more information about:

Applying to UIU

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Speak to my admissions counselor

I learned about UIU from: Please select . . . Family Friend General Reputation – Word of Mouth High School Coach High School Counselor High School Teacher College Fair High School Visit Athletic Event or Camp UIU student Graduate of UIU UIU Coach UIU Staff or Faculty UIU Web site Search of the Web Billboard Magazine Newspaper Email Direct Mail Radio Television Other