Iowa Central Admissions Application

Students on Fort Dodge Iowa Central Campus

Iowa Central Application
* indicates a required field

Personal Information

Enter your name as it appears on your Social Security Card

*First Name (given name):

Middle Name/Initial:

*Last Name (surname):

SSN:

*Birth Date (month/day/year):

Sex/Marital Status:

Female/Married Male/Married
Female/Single Male/Single

Maiden Name:

*Address:

*City:

County:

State:

Zip Code:

*Phone:

Work Phone:

*E-Mail:

Iowa Resident: Yes No
Date of Residency:

US Citizen: Yes No - If no:

Country of Birth:
Country of Citizenship:
Type of Visa:

Is English your native language?

Yes No

Ethnicity: (optional)

Housing Information

Do you wish to receive a residence hall app:

Yes No

Emergency Contact Information

Contact:

Father Mother
Spouse Guardian

Other:

*Name:

*Phone:

Program Major Information

*I am pursuing a major in:

Admissions Information

Term:

*What Center do you plan to attend?

Have you ever taken a credit course at Iowa Central? Yes No

What center?
Year(s)
Degree(s)

Identify your reason for attending Iowa Central:

To meet certification/licensure requirements

Transfer to another college

Explore courses to decide on a career

Self-improvement/Improve basic skills

Prepare to enter the job market

Undecided/Unknown

Improve skills for present job

Prepare to change careers

Personal Interest

While enrolled, I plan to be employed:

15 hours or less per week

16-25 hours per week

26-39 hours per week

40 hours per week

More than 40 hours per week

Do not plan to be employed

How long do you plan to attend Iowa Central:

One semester One year or less Two years Three Semesters

Are you a U.S. Military veteran?: Yes No

Will you receive Veteran's benefits?: Yes No

Did either of your natural born or adoptive parents (with whom you were living before your 18th birthday) complete a bachelor's degree?

Yes No

I received information about Iowa Central from:

Another Student

High school Counselor

My parents

My employer

High school teacher

Newspaper

Radio

Iowa Central Website

Admissions Representative

Iowa Central Coach

Iowa Central Employee

Mail from Iowa Centra

Other

High School Information

*Name of High School/GED:

*Graduated/Completed:
(Month/Year)

City:

State:

Have you ever earned college credit from any other college or university?
Yes No

Full name of institution(s):

Degrees earned after high school:

Certificate Diploma Associate
Bachelor Master Doctoral

College:

Please be sure to fill out the form completely,
this will speed up your enrollment process.