Graduate School Contact Permission Request Form

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Annually the College of Engineering at Iowa State University receives a variety of requests from institutions across the U.S. regarding our junior and senior level undergraduate engineering students. The requests primarily take place during the fall term and involve the promotion of any or all of the following: fellowship opportunities, Ph.D. programs, funded campus visits, summer research internships, Masterʼs programs, application fee waivers, research symposium invitations, new scholarships, online graduate degrees, graduate recruiting events and other academic endeavors.

This is a great opportunity for you as a student to gain information about graduate opportunities at various institutions across the United States.

If you wish to participate, please take 30 seconds to complete this brief online form granting ISUyour permission and to release of a few basic ﬁelds ofthe specified information identified below to other U.S. higher-education institutions. Please note, this form grants ISU permission to release information that is potentially protected by the Family Educational Rights and Privacy Act (FERPA). Read carefully before signing.

Name*

First Last

Education Information

Undergraduate Institution

Undergraduate Major*

GPA*

Please enter a number from 0 to 4.00.

Graduation Month*

Graduation Year*

Masters Institution, if applicable

Masters Major, if applicable

Masters GPA, if applicable

Please enter a number from 0 to 4.0.

Masters Graduation Month, if applicable

Masters Graduation Year, if applicable

Graduate Interest Information

Graduate Degree of Interest*

Graduate Program of Interest (TOP CHOICE)*

Other Write In

Graduate Program of Interest (SECOND CHOICE)*

Other Write In

Personal Information

The following two questions are completely voluntary, and you may select “prefer not to answer” for any and all questions.

Sex

Female
Male
Prefer not to answer

Ethnicity

American Indian or Alaska Native: a person having origins in any of the original peoples of North and South America (including Central America), and who maintains tribal affiliation or community attachment.

Asian: a person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand, and Vietnam.

Black or African American: a person having origins in any black racial groups of Africa.

Hispanic: a Hispanic or Latino person of Cuban, Mexican, Chicano, Puerto Rican, South or Central American, or other Spanish culture or origin regardless of race.

Native Hawaiian or Other Pacific Islander: a person having origins in any of the original people of Hawaii, Guam, Samoa, or other Pacific Islands.

White: a person having origins in any of the original peoples of Europe, The Middle East, or North Africa.

Shift or Command key to select more than one.

Citizenship

U.S. Citizen
Permanent Resident
International

Contact Information

Iowa State University Email*

Enter Email Confirm Email

Please provide your Iowa State University email.

Phone*

Consent*

I understand that this authorization shall remain in effect as once that database is released to ~80 universities and colleges of engineering, it cannot be retrieved as it spreads to various graduate student recruiting databases at each institution. If you should change your mind, you will need to unsubscribe from each institutional email you receive and/or contact each institution to request removal from their local graduate recruiting databases.

Yes
No