Personal Background Information

First Name Middle Name/Initial

Last Name

Email Address

Mailing Address 1

Mailing Address 2

City ST Zip Code

Telephone Number

Date of Birth (MM/DD/YR)

Year in School High School Senior College First-Year College Sophomore College Junior

Major/Intended Major

Student ID Number/SSN

Country of Citizenship
Students must be a U.S. citizen or permanent resident to participate in this program.

Are you a permanent resident of the U.S.? Yes No

Ethnicity (check all that apply):
Alaskan Native or American Indian
(tribal affiliation )
African American / Black
Latino(a) / Hispanic
Pacific Islander
Asian American
White, not of Hispanic origin

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Tell Us About Yourself

A. Personal Essays

1. Tell us about your favorite science class. What did/do you like about it?

2. What makes you think you want to be a scientist? What draws you to science?

B. Activities & Experiences

Provide a profile of your school and community activities.  List names of organizations and activities,
leadership positions, honors and awards.

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Release of Information

By checking this box, I agree to this statement:

My academic standing is a factor for admission to IBA; therefore, I give IBA staff permission to obtain my transcripts. If I completed coursework at another college or university, I am responsible for submitting transcripts from that school to the University of Iowa Office of Admissions, and IBA may obtain a copy of those transcripts from Admissions.

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Letter of Recommendation

IBA will receive a letter of recommendation in support of my application from the following individual: . S/he will send the letter to:

Iowa Biosciences Advantage
24E PH
Iowa City, IA 52242
or fax it to 319/335-3145.