NCC Online Application For Admission

* Fields with an asterisk are REQUIRED.

Note: The information contained below is exclusively for Northwest Iowa Community College use only. It will not be released from our files.

 


 

Student Identification:  
social security #:*No dashes in SS#  
date of birth:* example: 00/00/0000
gender:* male: female:
last name:*
first name:* MI:
previous last name:
email address: Enter "none" if you have no email address
Address Information:  
street:*
city/town:*
county:* 
state/country:*
zip code:*
home phone:* Include area code, example: 000-000-0000
work phone: Include area code, example: 000-000-0000
Resident Information  
Are you an Iowa resident?* yes: no:
Are you an US citizen?* yes: no:
If no, state type of Visa:*
Is English your native language?*  yes: no:
Will you receive veteran's benefits at NCC?*  yes: no:
Are you a veteran of the US Military?*  yes: no:
My ethnic/racial background is:* 
Educational Background Information  
What best describes your educational background?
In high school and will graduate month/year    example: 00/0000
High School Graduate
High School Equivalency (GED)
Not a high school graduate
Attended another college and NOT a HS graduate
Attended another college and a HS graduate
4-year college graduate
Enter the name of the high school from which you were or will be graduated.
Non-graduates list last high school attended.
name of school:*
name of school:*
city/state:*
graduation year:*
non-graduates attended from/to:
highest degree earned at another postsecondary institution:*
1 = diploma
2 = 2-year degree
3 = 4-year degree
4 = graduate degree
5 = certificate
6 = none
7 or blank = unknown
List all collegiate institutions you have attended or are now attending.
If you have never attended a collegiate institution, enter "none".
(Transfer students must contact their previous institution for an official transcript.)
Institution name #1:
city:
state:
dates attended from: example: 00/0000
dates attended to: example: 00/0000
Institution name #2:
city:
state:
dates attended from: example: 00/0000
dates attended to: example: 00/0000
Institution name #3:
city:
state:
dates attended from: example: 00/0000
dates attended to: example: 00/0000
Major or Program applying for:*
Applying for term beginning:*
  Year: 
Will you be:* Full-time or  Part-time (less than 12 hrs.)
Do you intend to pursue a degree, diploma or certificate at NCC:* Yes  No
Do you intend to transfer to another college/university:* Yes  No
By entering your full name and date below, you are certifying that the above statements are true and correct to the best of your knowledge. You also agree to abide by all approved college policies as outlined in the current college catalog.
Today's Date:*   example: 00/00/0000
Full Name:*
Voluntary answer
** All students are required to take the COMPASS before acceptance.
News Releases
We would like to prepare a news release for your newspaper after acceptance to NCC.
Please indicate the name and address of your newspaper.
Newspaper name:
street:
city/town:
state:
zip code:
You may submit this form "online" by pushing the Send Application button,
or simply print this form out and mail it to the college address below, to the attention of Student Services.

Reminder - This application will not be processed without the $10.00 application fee.
If you would prefer to take care of the payment now, you may do so here:
Card being used: Visa Mastercard Discover
Card number:
Expiration date: example: 00/00/00 
Your name as it appears on card:
 
 

Note: The information contained above is exclusively for Northwest Iowa Community College use only.
It will not be released from our files.