Application for Assistance - Step 2 of 6

Account Information

Please enter your information for online account access.

Passwords must be: At least 8 characters long (alphanumeric). Include at least one special character (e.g. !, @, #, $, ^, *, etc.). A mix of uppercase and lowercase letters. You may not use pieces of your name or email address in your password.

We were unable to process your form. Some information was either missing or not understood.

Please check the following, and submit the form again:

User Name*   @IOWAID
Re-Enter Password*
First Name*
Last Name*
E-Mail Address*

* Indicates required data