College Credit Application for 
Project Lead The Way (PLTW) Engineering Courses

Student Information

* Student First Name
Student Middle Name
* Student Last Name
* Student Birthdate   
* Gender
* Race/Ethnicity
* Expected High School Graduation Year
* Street Address
* City
* State
* Zip
* County
* Student Phone
* Student's Email Address

Parent / Guardian Information

Set parent/guardian's
address the same as
the student's?
* Parents Name
Parent's Address
Parent's City
Parent's State
Parent's Zip Code
* Parent's Email Address

Course Information

* High School
Other High School
(if not listed above)
* Selected PLTW Course
* Teacher's Name
* Teacher's Email

Have you ever received college credit from the University of Iowa for a different PLTW course?

Received Credit

Signature

In the field below, please enter your FULL NAME. This will serve as a binding electronic signature for this form. Your electronic signature indicates that the University of Iowa has your permission to exchange Project Lead The Way information with your parent/guardian and your PLTW teacher and/or school designee.

* Signature

Total Cost: $150.00, due at time of this application. After you click the NEXT button at the end of this application, you will be redirected to a page with a link where you can pay the non-refundable $150.00 application fee by credit card.

Please note that American Express is not accepted.

Congratulations on receiving college credit for your Project Lead The Way course!

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