ICN reservation request form

This form is for ICN scheduling requests only. Students requesting information about Continuing Education courses should contact Continuing Education at 319-273-2121 or 800-648-3864.

If you have not already done so, please read over the ICN Usage Guidelines before submitting your request.

Continuing Education will not provide your contact information to anyone outside our institution without your permission.

ICN RESERVATION REQUEST
Contact/Billing Information
Contact name
Contact e-mail
Contact phone
Acct # for billing
Course/Event Information
Instructor name
Course/Event name
Short description

Event topic

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Audience

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 Number of participants
Dates and Times
Start date
End date
Exceptions
 Dates on which event will not be held due to holidays, vacations, etc.
Days of the week
Monday Wednesday Friday
Tuesday Thursday Saturday
Start time
End time
Requested ICN Sites
Origination site
This is the site from which the instructor/leader will conduct the session.
Remote site(s)
These are the sites/cities to which the session will be transmitted.
Questions and Comments
Please provide any additional information that will help make your ICN experience a comfortable one.

Thank you for your request. We will be in contact with you to confirm your reservation and/or discuss further details.

UNI Continuing Education requests this information for the sole purpose of sending the information you have requested. We do not routinely release any of this information to anyone outside our institution without express permission. We do ask that you fill out all the registration items that apply to you.

The University of Northern Iowa is an equal opportunity educator and employer with a comprehensive plan for affirmative action.