Signature Page EPO - The University of Iowa College of Education

Important! Mail this page to us!

Your signature and full social security number are required for activation of your placement file.

Print this signature page by selecting PRINT from the FILE menu.

Complete all information below and mail this page to the Educational Placement Office immediately.

Upon receipt of your signature page, your papers will be processed.

Print Name:

Mailing Address:

City:

State:

Zip/Postal Code:

Email Address:

Full Social Security #:

Phone:

RELEASE INFORMATION
Employers may request names, contact information, and/or credentials of applicants for specific openings. Check one of the statements below authorizing or restricting the release of such information.

I authorize the EPO to release my name, contact information, and/or placement file at the request of bona fide employers.

I wish to have my name, contact information, and/or placement file released only with my permission.

SIGNATURE
I understand that the registration fee keeps my file on active status until August 31.
I agree to furnish requested information, to report positions taken, and to deal professionally and ethically with employers and with the Educational Placement Office.

Signature:_____________________________________

Date Signed:________________________

Mail To:

Educational Placement Office

The University of Iowa
N302 Lindquist Center
Iowa City, Iowa 52242

The University of Iowa requests this information for the purpose of activating your placement file with the EPO. No persons outside the University are routinely provided this information, except for items of directory information such as name and local address, without your consent. If you fail to provide the required information, the University may not activate your file with the EPO.

The University of Iowa prohibits discrimination in employment or in its educational programs and activities on the basis of race, national origin, color, creed, religion, sex, age, disability, veteran status, sexual orientation, gender identity, or associational preference. The University also affirms its commitment to providing equal opportunities and equal access to University facilities. For additional information on nondiscrimination policies, contact the Coordinator of Title IX, Section 504, and the ADA in the Office of Affirmative Action, 202 Jessup Hall.