Application for Joint Admissions Colleges of Liberal Arts, Business, and Education EICCD ~ The University of Iowa     PERSONAL DATA Social Security # ________________________   Name ____________________________________________________________________________________   Last First Middle Other name that may appear on Supporting documents Current Mailing Address ____________________________________________________________________ Number and Street     ________________________________________________ Phone (   )________________ City                                               State         Permanent Mailing Address __________________________________________________________________ Number and Street     ________________________________________________ Phone (   )________________ City                                               State         Email Address _____________________________________________________________________________   U.S. Citizen or Resident ____ Yes   ____ No         If No, country of citizenship ________________________     ADMISSION INFORMATION   High School Name _________________________________________________________________________   High School Address _______________________________________________________________________ Number and Street City State   H.S. Graduation Date ____________         H.S. completion by ____ Diploma   ____ Equivalency Certificate   Anticipated date of entry at the University of Iowa ______________________________________________       Semester   Year Have you ever been enrolled at the University of Iowa ____ Yes   ____ No     If Yes, during what Semester and Year? ____________________________________   Other Colleges attended prior to anticipated enrollment at the University of Iowa ____________________   Intended Program of Study at EICCD ____________________   Intended UI Major _____________________   I understand that I must complete an AA (Associate in Arts) Degree at CCC, MCC or SCC. I understand I must maintain a minimum 2.0 cumulative GPA based on all transferable course work from all colleges attended. I understand I must meet the same criteria (e.g., GPA, course requirements, and prerequisites) for admission to competitive programs as continuing University of Iowa students. I authorize EICCD to release confidential education record information (including grade reports and/or transcripts) to the University of Iowa. I certify that the foregoing information is true and complete to the best of my knowledge and realize that failure to provide official transcripts and other required information may result in the cancellation of admission or registration.   _____________________________________________________ ________________________________     Student Signature (required)     Date   _____________________________________________________ ________________________________     EICCD Registrar Signature (required)     Date