Last Name
First Name
MI
Maiden Name/Other Names Used
Birth date (Mo/Day/Yr)
/
/
Birthplace City
State
Mailing Address Line 1
Mailing Address Line 2
Apt #
City
State
ZIP
-
Permanent Address
Home Phone
(
)
-
Daytime/Work Phone
(
)
-
Ext.
Fax Number
(
)
-
Ext.
NOTE: NORTH CENTRAL INSTITUTE DOES NOT HAVE DSN CAPABILITY.
E-mail Address
(No Yahoo! addresses, please)
Are you a US citizen? Yes No
If no, what country are you a citizen? Type of Visa
How did you learn about NCI?
NCI Website Linked Website Friend Flea Market Flyers NCI Employee
Radio Newspaper Current Student Former Student Career Day NCI Briefing
Other - please specify No Response
SECTION 2 - ACTIVE DUTY MILITARY SERVICE INFORMATION
Check all that apply: USA USAF USN USMC Reserves Coast Guard National Guard Active Duty-Unit/Location
Rank Primary MOS
SECTION 3 - SERVICE MEMBERS/VETERANS
If you plan to receive Veteran's Benefits, check appropriate category:
Veteran New GI Bill VEAP Dependent of disabled/deceased Veteran
Veteran-Discharge Date (Mo/Day/Yr)
/
/
Did you receive an honorable discharge? Yes No
Do you have a service-connected disability? Yes No
NOTE: If you are a veteran, you must provide a certified true copy of your separation papers (DD-214). If on active duty, you must provide a copy of your 2-1 and certified true copies of any separation papers (DD-214).
SECTION 4 - EDUCATION AND PROGRAM ADMISSION INFORMATION
High School
City State
Grad. Date
/
/
OR
GED State awarding equivalency
Date GED awarded (Mo/Day/Yr)
/
/
Have you previously attended NCI or had a CIE?
Yes - Date (Mo/Day/Yr)
/
/
No
Are you applying for admission into a Certificate Program? (Residents only)
Yes
If Yes, what certificate program?
Aviation Maintenance Technology
Are you applying for admission into the Associate in Applied Science Degree in Aviation Technology?
Yes No
If Yes, what area of concentration?
Flight Maintenance Operations/Air Traffic Control Undeclared
Are you applying for our Credit Inventory Evaluation Service? Yes No
OR
Are you applying for an Update to a previously completed CIE Service? Yes No
NOTICE: North Central Institute makes no representation as to the acceptability of credits earned by students at North Central Institute by other institutions or promotion sections. The transfer of credits by other institutions is solely the decision of the accepting institution or promotion section.
Please initial (If submitting application online, your typed initials in this block will
certify your understanding of the above notice.)
SECTION 5 - ADMISSION STATUS
New student, first college attended
Transfer, will transfer credit in
Transfer, will not transfer credit in
Former student (indicate last term attended or last CIE date) Term/Date
/
/
Other
Last name under which you previously enrolled
Anticipated Date of enrollment: (Month/Year)
Fall
/
Winter
/
Spring
/
Summer
/
Plan to register (check all that apply):
Full time Part time Day
Evening
Both Other
Anticipated Date of Graduation (Mo/Yr)
/
NOTICE: Upon acceptance to North Central Institute, you will receive a current catalog.
Please initial (If submitting application online, your typed initials in this block will
certify your understanding of the above notice.)
SECTION 6 - COLLEGES AND UNIVERSITIES ATTENDED
School # 1
Location
Dates Attended - From (Mo/Yr)
/
to (Mo/Yr)
/
Number of Credits Earned
Degree Earned Associates Bachelor's Masters Doctorate
Has an Official Transcript been requested to be sent to NCI? Yes No
School # 2
Location
Dates Attended - From (Mo/Yr)
/
to (Mo/Yr)
/
Number of Credits Earned
Degree Earned Associates Bachelor's Masters Doctorate
Has an Official Transcript been requested to be sent to NCI? Yes No
School # 3
Location
Dates Attended - From (Mo/Yr)
/
to (Mo/Yr)
/
Number of Credits Earned
Degree Earned Associates Bachelor's Masters Doctorate
Has an Official Transcript been requested to be sent to NCI? Yes No
School # 4
Location
Dates Attended - From (Mo/Yr)
/
to (Mo/Yr)
/
Number of Credits Earned
Degree Earned Associates Bachelor's Masters Doctorate
Has an Official Transcript been requested to be sent to NCI? Yes No
*Official transcripts from each college/university previously attended required for all programs and services offered at NCI.
SECTION 7 - FEDERAL, STATE AND INSTITUTIONAL REPORTING DATA
As an affirmative and equal opportunity institution, North Central Institute prohibits discrimination in its policies, practices and procedures, but is required to submit statistical data on the composition of its student body. This information will be used for administrative purposes only.
SEX: Male Female
Ethnic Background (please check one):
01 American Indian, Alaskan Native
02 Asian or Pacific Islander
03 Black, Non-Hispanic origin
04 White, Non-Hispanic origin
05 Hispanic
06 Other
07 No Response
SECTION 8 - TUITION AND FEE INFORMATION
Application Fee: $35.00 (non-refundable) must be submitted with all applications for our Associate Degree and Aviation Maintenance Programs. This DOES NOT apply to CIE Services.
Unofficial/Official Credit Inventory Evaluation Fees are required for North Central Institute to process your application and documents.
Click here to view the required fees.
Fees and information are subject to change without notice. Please contact
Student Services for current information.
Notice: All fees are non-refundable. This includes Credit Inventory Evaluation (CIE)
Service fees.
SECTION 9 - SIGNATURE AND PAYMENT INFORMATION
NOTICE OF NON-DISCRIMINATORY POLICY: North Central Institute admits students of any sex, race, color, national and ethnic origin to all rights, privileges, programs and activities generally accorded or made available to students at the college. North Central Institute does not discriminate on the basis of handicap, race, color, sex, national and ethnic origin in administration of its educational policies, admission policies, scholarship and loan programs, and other school-administered programs. North Central Institute is an Equal Opportunity Employer.
I hereby certify that all answers I have given to all questions are correct and complete to the best of my knowledge. I agree to abide by all the policies and regulations set forth in official publications of the Institute. I understand that submission of false information may result in my dismissal from NCI.
If you are submitting your application online or via email, your typed name in the following block will certify your understanding of the above notice.
Signature Date (Mo/Day/Yr)
/
/
All fees must be submitted in US Currency only - payable to North Central Institute.
Amount $
(NOTE: If you are faxing your application to us,
you must include the $6.00 incoming fax fee in the amount above.)
Please indicate payment method: Money Order Visa MasterCard
Card Number Exp. Date
/
Authorized Cardholder (Required)
Signature (Required)
NOTE: To use a credit card, you must be the authorized cardholder. If you are not, the authorized cardholder MUST complete the NCI Authorization Form prior to any charges being made.
If you are submitting your application online or via email, your typed name in the above signature block will authorize North Central Institute to process your credit card for the indicated amount. Applications submitted any other way must be signed.
North Central Institute (NCI) makes no representation, as to the acceptability of credits earned by students at NCI by other institutions. The transfer of credits by other institutions is solely the decision of the accepting institution.
(Reference Form 2397-1)
Application fees are nonrefundable. Tuition may be refunded according to the program refund policies as published in the NCI Catalog.
All Information provided on this form is governed by the Family Educational Rights and Privacy Act (FERPA) of 1974, as amended. THIS FORM MAY BE REPRODUCED.