Iowa Central Commuity College

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.
*
Home Phone:
You must enter a home or cell phone number.Invalid format. Must be in (123) 456-7890 format.
*
Cell Phone:
You must enter a home or cell phone number.Invalid format. Must be in (123) 456-7890 format.
 
Can we text you?
 
Work Phone:
 Invalid format.
*
E-Mail:
(enter only 1 e-mail address)
A value is required.Invalid format.
*
Preferred Method of Contact:
 Please select an item.
 
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)

Test Scores

In order to help you take the appropriate Math and English courses, it's helpful, but not mandatory, to have your SAT or ACT test scores. Please respond to the following:

  SAT Verbal Score:
  SAT Math Score:
 
     
  ACT Verbal Score:
  ACT Math Score:
 

Certification Information You must check the box to the left in order to submit the form.
By checking this box I certify that the above statements are true and correct to the best of my knowledge. 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.

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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