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Application Forms

Admission Application

  

Please fill out the application form thoroughly and accurately. 

Do not use the forward or back buttons on your browser at any time while completing this application, you could lose everything you've entered.

Personal Information
First Name
Last Name
Middle Name (Enter NMN for None)
Date of Birth -- mm/dd/yy
Sex Male Female
SSN Number (International enter 111-11-1111)

Race?

 Are you Hispanic and/or Latino? Yes No

 

 Select one or more races:

*Hold down CRTL to select more than one race.

 

Marital Status?
Are you a Veteran?
If yes, do you plan to use VEAP?
Were you referred by an agency?
Are you a US Citizen? If No
Are you a Kansas Resident?
Local Contact Information
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Work Phone
Home Phone
E-mail
Legal Address (Leave Blank if same)
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Phone
Legal county of residence?
Date of Kansas residency? -- mm/dd/yy
   
In Case of Emergency Contact Person
Name
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
Education History
What Semester do you plan to enter ICC?
What year do you plan to enter ICC?
Student Classification?
Are you currently in High School? If Yes
Did you graduate from High School? If No
Year of Graduation?
Name of High School and Location?
Jump to next Question
GED Information
If no, have you taken the GED?

Location?.

Date you took the GED?

 -- mm/dd/yy
List All Prior Colleges
College Name City/State Date Hours Earned
Kansas law requires an official transcript be sent from each institution you have attended. It is your responsibility to make sure that each transcript is sent to ICC.

 

In addition to your application, if you are applying for scholarships and/or financial aid, or plan on graduating from ICC, it is required that you provide a final transcript from your high school or GED. Any college Registrar should be directed to the Registrar’s Office. All records submitted to the college become the property of ICC and will not be returned to the student. Any change of address or name

must be filed with the Registrar’s Office immediately.

International Student Information
Visa type
Country of Birth
INS Admission number
Country of citizenship
Resident Alien A#
Resident Alien Date -- mm/dd/yy
Country of Origin
Date Moved to Kansas -- mm/dd/yy
County living in
Degree Plans  
Are you seeking a degree? * If No
What type of degree are you seeking
Select your major area or select areas of interest if undecided on your major

Transfer-Oriented

Accounting
Administrative Office Management Specialist
Architectural Engineering Technology
Art
Athletic Training
Biology
Business Administration
Chemical Engineering Technology
Civil Engineering Technology
Communication
Computer and Information Technology
Computer Information Systems
Computer Programming
Computer Science
Construction Engineering Technology
Cosmetology

Criminal Justice
Drafting/CADD Engineering Technology
Early Childhood Education
Elementary Education

Secondary Education
Engineering Technology
English

Entrepreneurship/Management
Foreign Language
History
Information Word Processing
Legal Office Specialist
Liberal Studies

Manufacturing Engineering Technology
Mathematics
Mechanical Engineering Technology

Media
Medical Office Specialist
Music
Physical Education/Recreation

Physical Science
Pre-Law
Pre-Nursing
Psychology
Secondary Education

Small Business Management
Social Science
Sociology
Theatre
Web Design and Development

Occupational and Technical-Oriented

Administrative Office Management Specialist

Automotive Engine Repair Technician

Certified Medication Aid

Certified Nurse Aid

Computer and Information Technology
Computer Programming
Cosmetology

Culinary Arts

Emergency Medical Technician

Home Health Aid
Information Word Processing Specialist
Legal Office Specialist
Long Term Care or Home Health Care

Manufacturing Skills
Medical Office Specialist

Public Management

Small Business Management

Theatre Arts (Playwriting)
Theatre Technology
Web Design and Development

Welding

Woodworking
ICC is committed to a policy of non-discrimination involving equal access to education and improvement to all regardless of race, gender, national origin, religion, age, and disability in admissions, educational programs or activities, and employment, all as required by applicable law and regulations under the Title VI Civil Rights Act of 1964, Title IX regulations of 1972, Section 504 of the Social Rehabilitation Act of 1973, and Americans with Disabilities Act (ADA) of 1990.

You have the right to notify this institution if you have a disability that may require a reasonable modification or accommodation.

Where did you find out about ICC?
Newspaper TV College Fair
Class Schedule Radio Word of Mouth
College Catalog Internet High School Visit
What are your Educational Objectives?
Transfer to another college/university
Enter job market
Personal/self improvement
Improve skills for present job
Improve basic Skills
Prepare for a job change
The following information is used to monitor compliance with several federal and state statutes. You are not obligated to respond, and if you do, your response will not affect your admission.
Does either parent have a bachelors degree?
Are you or will you be receiving financial aid?
Have you filled out the Free Application for Federal Student Aid (FAFSA)?
Approximate family income
Have you attended any other colleges?
Form Complete!

All finished! Click on Submit below to validate the form. If any errors are found, you will be told where the error is, and in some browsers taken to the location. After correcting the error, click on submit again to repeat the process. If for some reason you are unable to submit the form, print it and mail it to: Independence Community College, Attention: Admissions, PO Box 708, Independence, KS 67301 or fax the completed form to 1 (620) 331-0946

By clicking "Submit Form" below, I certify that all the information is complete and correct.I understand that the college will use the data provided on this form to assist in assessing institutional needs and that all of the information will be kept confidential. I release the following information to the ICC staff including but not limited to: high school transcript, COMPASS/ACT/SAT scores, ICC graduate reports and instructor evaluations, financial assistance award notices and income information, vocational rehabilitation records and any other information from my academic records pertaining to my enrollment at ICC.