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Startup Games Application Fall 2022
You must have JavaScript enabled to use this form.
FIRST NAME
LAST NAME
STUDENT ID NUMBER
(Example: 00888888)
E-MAIL
PHONE NUMBER
Type all 10 digits in a row. Do not include hyphen. (Example: 3198675309)
T-SHIRT SIZE
S
M
L
XL
XXL
UNI-SEX SIZES
PLEASE LIST ANY DIETARY RESTRICTIONS YOU HAVE
STATUS WITH THE UNIVERSITY OF IOWA
- Select -
Undergraduate student
Graduate student
Other
YEAR IN SCHOOL
YEAR IN SCHOOL
- Select -
Freshman
Sophomore
Junior
Senior
Other…
Enter other…
MAJOR(S)
MINOR(S)
CERTIFICATE(S)
COLLEGE
Medicine
Dentistry
Education
Engineering
Law
CLAS
Nursing
Pharmacy
Public Health
Business
Graduate
University
HAVE YOU PARTICIPATED IN STARTUP GAMES BEFORE?
Yes
No
You may participate in Startup Games for one credit hour. Are you interested in this option?
Yes
No
Are you able to attend a required Conditioning Event on Oct. 5 from 5-7 p.m. in S401 PBB? If not, we will have a makeup time - please note when you are available.
On the weekend of the event, are you available from 4 p.m. on Friday until 5 p.m. on Sunday?
Yes
No
If you answered no to the previous question, when will you NOT be able to attend?
Why do you want to participate in Startup Games and what skills do you bring to the table?
Do you have an idea for a startup? If yes, give us a brief description. If no, it's no problem!
How did you hear about this event? (Check all that apply)
Former Startup Games Participant
Classroom Visit
Iowa JPEC Website
Our Snazzy Posters Around Campus
Social Media
E-mail from Startup Games Team
Other or Referred by:
REFERRED BY:
Media Release Consent
Yes, I grant media permission
No, I do not grant media permission
By checking the box above, I hereby consent to allow to be photographed during Startup Games. I hereby grant to the University of Iowa the rights to use my image, name, and/or likeness in any medium whatsoever for the purpose of promoting the University of Iowa or any of its units without any payment to me. I hereby expressly waive any rights of I action I may have and release the State of Iowa; Board of Regents, State of Iowa; the University of Iowa, and their employees and agents from any and all liability arising out of or in connection with the use of such image, voice, name, and/or likeness, including, but not limited to, any claims for any violation of any personal or proprietary right. The university, its successors and assigns shall own all right, title, and interest, including without limitation the copyright of any such photograph, video-recording, and/or audio-recording.
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