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):
Maiden Name:
SSN:
*Birth Date (month/day/year):
Sex: Female Male
*Address:
P.O. Box:
*City:
County:
State: Zip Code:
Home Phone:
Cell Phone:
I would like to receive text messages about upcoming events at Iowa Central:
Cell Phone Carrier:
*E-Mail:
(please only enter 1 e-mail address)
Iowa Resident:
Date of Residency:
Are you a US Citizen: - If no:
Country of Birth:
Country of Citizenship:
Type of Visa:
Is English your native language?
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

Emergency Contact Information

Contact:
Other:
*Name:
*Phone:

Admissions Information

*What Center do you plan to attend?
Term:
Status Entry:
How long do you plan to attend Iowa Central:
Did either of your natural born or adoptive parents (with whom you were living before your 18th birthday) complete a bachelor's degree?
The above information is requested to determine your eligibility for federally-funded assistance programs and will NOT be used in determining admission.

Program Major Information
Select ONE program that you are planning to major in:
   
Please check the extra-curricular activities that interest you:
Dance Line
Music-Instrumental
Music-Vocal
Newspaper (Collegian)
Spirit Squad (Co-Ed)
Student Ambassador
Student Government
Theatre
   
Men's Intercollegiate Athletics:

Baseball
Basketball
Cross Country
Football
Golf
Rodeo
Soccer
Swimming
Track and Field
Wrestling
   
Women's Intercollegiate Athletics:

Basketball
Cross Country
Golf
Rodeo
Softball
Soccer
Swimming
Track and Field
Volleyball
   

High School Information
*Name of High School Last Attended:
*Graduated/Completed:
(Month/Year)
City:
State:
Are you currently attending High School:
If not a high school graduate, have you earned the GED:
Date GED Earned:
Where GED Earned:

College Attendance Information
List all colleges and universities including Iowa Central, that you have previously attended. Remember to contact each college and request an official transcript be sent to: Student Records, Iowa Central Community College, One Triton Circle, Fort Dodge, Iowa, 50501
College Name
City, State, ZIP
From (mo/yr)
To (mo/yr)

Housing Information
Do you wish to receive a residence hall app:
 

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.

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