NEXus Registration and Tracking | Distance and Online Education

Date of Birth

Sex

Female

Intersex

Male

Prefer not to answer

Gender

Agender

Cisgender

Man

Non-binary

Transgender

Woman

Another gender not listed

Prefer not to answer

Last Name

First Name, Middle Initial:

Address 1:

Address 2:

City:

State:

Zip Code:

County

Phone:

Email, list an email that you check daily

Confirm email

Citizenship of the USA

Yes

If not a US citizen, enter country of citizenship.

Ethnicity / Race / Tribal Affiliation (optional)

Hispanic/Latinx (optional)

Yes

Veteran (optional)

Yes

Home Institution and Program

Student Status:

PhD

DNP

Masters

COURSE ENROLLMENT REQUEST

Term and Year *

Course Number and Title

Credits (semester/quarter)

ENROLLMENT ACKNOWLEDGEMENT

My e-signature indicates the above information is factually correct and complete. With the information collected in this webform, I will be admitted, as a Distance and Online Education non-degree student, to the University of Iowa. I plan to complete the enrollment in the course requested above, at the University of Iowa, for academic credit as noted. The information that I have provided is for admission purposes. No persons outside the university are routinely provided this information, except for directory records. The University of Iowa will bill me for tuition and fees in accordance with my enrollment. I understand that I will need to take additional steps to complete the enrollment process.

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