NCC Application

Before this application will be processed, students need to: 1. Submit official copies of high school and college transcripts. (Cannot accept student-issued transcripts.) 2. Submit a $10.00 non-refundable application fee. (You may pay by credit card at the bottom of this form if you wish) 3. Complete the COMPASS (COMputer-adapted Placement Assessment and Support Services). ** Call for an appointment. Type answers to ALL items and click "Send Application". Thank you for your interest in Northwest Iowa Community College.
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:*
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:*
Fall
Spring
Summer
Other of 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 ASSET** 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 appication fee.*


Note: The information contained above is exclusively for Northwest Iowa Community College use only. It will not be released from our files. (Social Security Numbers are not secure on this site at this time)