NIACC Application for Admission

500 College Drive Mason City, Iowa 50401
641-422-4245 or 1-888-GO NIACC, ext. 4245

You will be given an opportunity to print the application after the form has been submitted.

 

Personal Information 

* required fields
Application Date
Social Security # *  - -
Name (full name)*
Maiden Name
Street Address*
City/State/Zip *
Home Phone  ( ) - -
Work Phone ( ) - -
Date of Birth:*   
Your email Address:
Gender: * Male  Female

Residency
* required fields
I am a documented resident of Iowa living in county.
I have lived in Iowa for the past 90 days.
I am an OUT OF STATE student and a documented resident of the state of .
I am an International student and am a citizen of .
Birth Country: * required for international students only
Visa Type: * required for international students only
Ethnic information: (optional)
English is my native language.

Enrollment Information
* required fields
Term Beginning:
Will you be taking Classes at:
Mason City Campus Satallite Campus Online only
NIACC is your:    
First choice Second choice Third choice
How long do you plan to attend NIACC?
One semester Summer school only
One year Two years More than two years
What is your goal in attending NIACC?*
What award are you seeking at NIACC?*
Please choose one proposed program:*

(Program options are displayed when a proposed program is selected. Click on down arrow to see list of program options, then click on the one you wish to choose) *

Transcripts
* required fields
Last high school attended:*
If not listed, please enter School information.
School:
City : 
State :
Zip Code:
Year of graduation:
If you received a GED (General Educational Development) high school equivalency diploma, indicate year attained:
If you have taken college credit classes from Mason City Junior College or North Iowa Area Community College, please indicate the year(s):
If you have attended any other college/university, please indicate below:
School Attended:
City and State:
Dates attended:
Degree:
School Attended:
City and State:
Dates attended:
Degree:
Please have your college/university transcripts forwarded to NIACC as soon as possible. (This is not required of summer school students.)

Publicity
* required fields
We would like to