Iowa Lakeside Laboratory - Registration and Housing Form

Application Fee

There is a non-refundable $40 application fee. This fee should be sent as soon as possible to Iowa Lakeside Laboratory's Administrative Office. You will not be registered in the course(s) selected or have housing reserved for you until this fee is received. Make your check or money order payable to Iowa Lakeside Laboratory.

You can register over the Web by filling in the form below or you can download the Registration and Housing Form as an Adobe Acrobat (pdf) file. Please mail the completed form to the Iowa Lakeside Laboratory's Administrative Office along with your $40 application fee

Name and Address

Note: Items in "green" must be filled in or form will not be processed.

Name:

USA Social Security Number or University of Iowa Student ID Number:
(If you are an international student and do not have a valid US SSN, please enter 999-99-9999)

Current (and permanent, if not same as current) mailing address(es):

Daytime telephone number:

Evening telephone number:

Email address:

Date of birth:

What is your gender?

Birthplace: Country

Citizenship, if not US:

Type of VISA, if not US citizen:

If you are in the US on an F1 visa, please enter the name and location of your home institution:

and the expiration date of your current I-20 form:

Education / Student Status

Are you registering as a/an:

undergraduate student
graduate student

University degree(s), include date and institution(This section must be completed if seeking graduate credit.):

University at which you are currently enrolled:

Are you pursuing a degree from one of the following:

If you chose an institution in the question above,
enter your ISU/UNI/Drake/ILCC student ID #

If you are pursuing a degree from ISU or UNI, will you be applying for
Summer financial aid through your home institution (ISU or UNI)? Yes No

Lakeside Courses Being Requested

NOTE: To sign up for Internship, Independent Study, or Research courses, you must first contact the Iowa Lakeside Laboratory to get the Executive Director's approval to take these courses. It is not possible to register for these courses online.

First Term (May 18 to June 12, 2009):

If you registered for a First Term course above, do you wish to take it for academic credit or on a non-credit (audit / 0 s.h.) basis? (Tuition fees are the same for credit or audit registrations.)
Credit Non-credit(audit)

Second Term (June 15 to July 10, 2009):

If you registered for a Second Term course above, do you wish to take it for academic credit or on a non-credit (audit / 0 s.h.) basis? (Tuition fees are the same for credit or audit registrations.)
Credit Non-credit(audit)

Third Term (July 13-24, 2009):

If you registered for a Third Term course above, do you wish to take it for academic credit or on a non-credit (audit/0 s.h.) basis? (Tuition fees are the same for credit or audit registrations.)
Credit Non-credit (audit)

Lakeside Scholarships

Iowa Lakeside Laboratory offers merit scholarships that cover basic room and board charges. To qualify applicants must have a cumulative GPA of 2.5 or higher.

Would you like to be considered for an Iowa Lakeside Laboratory Scholarship? Yes No

If you answered yes, submit a 100-200 word essay via e-mail describing your qualifications and motivation for taking courses at Iowa Lakeside Laboratory, and arrange to have an official copy of your current transcript sent to Iowa Lakeside Laboratory before April 1, 2009. (Transcripts should be sent to Iowa Lakeside Laboratory, 1838 Highway 86, Milford, IA 51351-7267. Essays should be e-mailed to peter-vanderlinden@uiowa.edu.)

Housing

Two kinds of housing are available: motel-style units with bathrooms and cabin-style units without bathrooms. The latter are served by two bathhouses. Most housing is double occupancy. Room and board is available as a package: cabin-style without a bath, $195/wk.; double occupancy with bath, $247/wk.; or single occupancy with a bath $379/wk. Housing is assigned on a first come, first served basis.

Are you requesting housing? Yes No

If you answered "No", there is no need to fill out the rest of this form.

Age:

When will you require housing:

First Term:

Second Term:

Third Term:

Type of housing preferred:

Comments

In order to make your time at Lakeside as comfortable and productive as possible, please use the comment box below to provides us with any additional information that would be helpful or requests that you might have. You can also use this comment box to request additional information about courses, registration procedures, housing, fees, etc.

Comments:

Confirmation:

You will receive confirmation that your on-line Registration/Housing Form was received in a few moments. A letter of confirmation will also be sent to you via e-mail. Your application fee ($40) must be received by the Iowa Lakeside Laboratory's Administrative Office before you will be registered or assigned housing.

(Note: Submissions may take 30 seconds to process. Your browser will be directed to a new page when the process is finished. Please do not select the "Submit Form" button more than once.)

Revised July 9, 2009

Registration and Housing Form