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. Musat be in 123-45-7890 format.
*
Sex:
Please select an item.
 
Maiden Name:
*
Marital Status:
Please select an item.
*
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.
 
Employer:
A value is required.
 
Employer's Phone Number:
Invalid format.
 
Are you a US Citizen:
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
*
Select ONE program that you are planning to major in: 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.
Another Student High School
Another Person Newspaper
Iowa Central Website Radio
Internet Search Mail from Iowa Central
Admissions Representative Email
Iowa Central Employee Social Media
    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
*
Name of High School/GED:
A value is required.
*
Year Graduated/Completed:
A value is required.
*
City:
A value is required.
*
State:
A value is required.
*
Zip Code:
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 on the basis of race, color, national origin, sex, disability, age (employment), sexual orientation, gender identity, creed, religion, and actual or potential parental, family or marital status in its programs, activities, or employment practices as required by the Iowa Code §§ 216.6 and 216.9, Titles VI and VII of the Civil Rights Act of 1964 (42 U.S.C. §§ 2000d and 2000e), the Equal Pay Act of 1973 (29 U.S.C. § 206, et seq.), Title IX (Educational Amendments, 20 U.S.C. §§ 1681 – 1688), Section 504 (Rehabilitation Act of 1973, 29 U.S.C. § 794),  Age Discrimination Act of 1975 (34 CFR Part 110), and Title II of the Americans with Disabilities Act (42 U.S.C. § 12101, et seq.).

If you have questions or complaints related to compliance with this policy, please contact Kim Whitmore, Director of Human Resources, phone number 515-574-1138, whitmore@iowacentral.edu; or the Director of the Office for Civil Rights, U.S. Department of Education, Citigroup Center, 500 W. Madison, Suite 1475, Chicago, IL 60661, phone number 312-730-1560, fax 312-730-1576.

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