Jacobson Entrepreneurship Academy Application

Iowa City, July 19-23, 2010

There is a fee of $175 per student for the weeklong camp. The fee helps cover costs that include instruction, class materials, camp t-shirt, bus transportation for tours, snacks, lunches and the graduation reception. A limited number of scholarships are available for those in need; please contact the Jacobson Institute for details. Iowa City participants may elect to drop their children off early (7:45 a.m.) and pick them up late (until 5:30 p.m.) for an additional fee of $10 per day.

Students selected for the program will be notified by mail on or before June 4, 2010. Payment will be due upon notice of acceptance.

If you have any questions or would like more information, please contact Dawn Bowlus at 319-335-0985 or dawn-bowlus@uiowa.edu.

Please complete the following:
First Name
Last Name
School Name	School City
Parent/Guardian
Home Address
City	State Zip
Home Phone
Parent/Guardian Cell Phone
Parent/Guardian Email
Grade you are completing
Age
Gender	M F
How did you learn about this camp?	If Other, please identify
Are you an Invent Iowa participant?	Y No
Extended Hours (Iowa City Participants):
I would like to register my child for the extended hours program for an additional fee of $10 per day. Early drop off in the morning begins at 7:45 a.m. and late pick up ends at 5:30 p.m. Yes No
Parent or Guardian
I recommend for participation in the Jacobson Entrepreneurial Camp to be held on the campus of The University of Iowa in Iowa City, IA, and I agree to attend the formal graduation ceremony upon my son/daughter’s completion of the program.
Parent/Guardian Name	Date
Parent/Guardian Name	Date