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Enter name in full:
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If previously enrolled at UNI or elsewhere under another name, enter that name: |
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Current Address:
(Please note: We mail out grades and other course material regularly throughout the duration of the course. Please
provide us with the address to which you would like these documents mailed.)
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Country:
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Permanent Address:
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Country:
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Phone:
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Residency: |
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Are you a United States citizen? *
Yes
No
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What is your country of citizenship?
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Do you consider yourself an Iowa resident? *
Yes
No
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Dates you have lived in Iowa: |
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Never
From birth to present
From:
To:
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4. |
Legal Sex (based on official identification): *
Female
Male
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Gender (self-identified, may be different than legal sex):
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Birthdate: *
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From what high school did you graduate? |
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7. |
For what courses do you wish to enroll?
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I am enrolling for: *
Undergraduate Credit
Graduate Credit
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9. |
Have you been enrolled previously or earned credit at UNI? *
Yes
No
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10. |
College Record: List colleges you have attended (other than UNI). |
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Notice:
For students who wish to receive graduate credit, verification of degree(s) is required. The University of Northern Iowa will attempt to verify degree(s). If we are unable to obtain verification we will request students contact the institution(s) that awarded the degree(s) (BA or higher) to have verification sent directly to UNI. Failure to provide such verification will cause classification to be changed to undergraduate status.
Authorization:
By electronically signing below, I hereby authorize, without reservation, any party or agency contacted by the University of Northern Iowa, any of its agents, or any entity employed by the University of Northern Iowa for such purposes to furnish the above-mentioned information.
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Will you use this course to meet UNI degree requirements? *
Yes
No
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If Yes, which degree? |
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Are you claiming Veteran's Administration Educational Benefits? *
Yes
No
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The U.S. Office of Education, in compliance with the Civil Rights Act of 1964, requires institutions of higher education to compile and report enrollment data on students, broken down as to racial ethnic composition. These data are for statistical purposes only and will be treated confidentially. |
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Do you consider yourself to be of Hispanic/Latino/Spanish origin?
Yes
No
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Please select one or more of the following racial categories to describe yourself: |
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Email Address: * |
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Continuing & Distance Education will use this email to send important information about your course and next steps. Please provide an email you check regularly. |
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Enter the text exactly as it appears in the picture below.
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As a result of clicking below, your information will be submitted for approval. After submission you will have an opportunity to view your completed form and print a copy.
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Please note that your enrollment request will be reviewed to ensure eligibility to register for coursework. This process ordinarily takes two to three days, after which the course(s) will be added to your schedule within your Student Center.
The University of Northern Iowa requests the information included in this form for the purposes of enrollment. No persons outside the University are routinely provided this information, except for items of directory information such as name and local address. Release of any information is governed by Board of Regents rules and applicable state and federal statutes.
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