Iowa Central Online Admissions Application

This is the online education program application for Iowa Central Community College Online. Your application is not considered complete until all materials are received.

Your information is secure and will remain confidential. Our site uses SSL encryption to secure the communication of all sensitive information passing between your browser and our server.

* indicates a required field

Personal Information

Enter your name as it appears on your Social Security Card

First Name (legal name):

A value is required.

Middle Name/Initial:

Last Name (surname):

A value is required.

Birth Date (MM/DD/YYYY):

A value is required.Invalid format. Must be in MM/DD/YYYY format.

SSN:

A value is required.Invalid format.Invalid format. Must be in 123-45-7890 format.

Sex:

Please select an item.

Maiden Name:

Address:

A value is required.

P.O. Box:

City:

A value is required.

State:

A value is required.

Zip Code:

A value is required.

Cell Phone:

You must enter a home or cell phone number.Invalid format. Must be in (123) 456-7890 format.

Can we text you?

E-Mail:
(enter only 1 e-mail address)

A value is required.Invalid format.

Are you or a family member a veteran?

Relationship:

Please select an item.

Are you a US Citizen:

Please select an item.

If you answered no, please make a selection below:
*	Please select an item.

Is English your native language?

Please select an item.

Ethnicity: (check all that apply)

Hispanic/Latino
White
Native Hawaiian or other Pacific Islander
Black or African-American

Asian
American Indian/Alaskan Native
Other Ethnic Group
Prefer not to Respond

Program Major Information

*	First, select how you plan to take classes at Iowa Central: Please select an item.
*	Then select ONE program you are planning to major in from the options available: Please select an item.

Admissions Information

Identify your reasons for attending Iowa Central (Select all that apply):

Minimum number of selections not met.

	For growth and advancement in career field		Prepare to enter the job market
	Transfer to a four-year college		Explore courses of interest
	Prepare to change careers		Other
	To meet certification/licensure requirements

I received information about Iowa Central from (Select all that apply):

Minimum number of selections not met.

	Iowa Central Website		Social Media
	Internet Search		Email
	Another Student		TV
	Another Person		Mail from Iowa Central
	Admissions Representative		Newspaper
	Iowa Central Employee		Radio
	High School		Other

If another student or person referred you, please provide their name:

Have you previously attended Iowa Central?

Please select an item.

High School Information

*	High School Name/GED:	A value is required.
*	Graduation Year/GED Year:	A value is required.
*	City:	A value is required.
*	State: (enter NA if not applicable)	A value is required.
*	Zip Code: (enter NA if not applicable)	A value is required.

College Attendance Information

College Name	City, State, ZIP	From (mo/yr)	To (mo/yr)

Certification Information You must check the box to the left in order to submit the form.
By checking this box, I certify that all information submitted in my application is my own work, accurate, and complete. I agree to abide by all approved policies as outlined in the current issue of the college catalog. I agree to report all changes, including name and address, to the Admissions Office. I authorize all schools attended to release requested records and permit Iowa Central Community College to verify any information provided. I understand that submitting false, incomplete, or misleading information, or engaging in fraudulent activity, may result in denial of admission, revocation of admission, or dismissal, and may be subject to additional actions under federal and state regulations.

Non-Discrimination Statement
It is the policy of Iowa Central Community College not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, gender identity, creed, religion, and actual or potential family, parental, or marital status.

If you have questions or complaints related to compliance with this policy, please contact Stacy Ihrig, Executive Director of Human Resources, One Triton Circle, Fort Dodge, Iowa, 50501, Telephone: (515)-574-1138, Email: concerns@iowacentral.edu, or the Director of the Office for Civil Rights U.S. Department of Education, John C. Kluczynski Federal Building, 230 S. Dearborn Street, 37th Floor, Chicago, IL 60604-7204, Telephone: (312) 730-1560, Facsimile: (312) 730-1576, TDD 800-877-8339 Email: OCR.Chicago@ed.gov.

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