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Home
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High School Student Enrollment
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High School Student Enrollment Form
In this Section
High School Student Enrollment Form
High School Student Enrollment Form
Date
*
MM slash DD slash YYYY
Name
*
First
Last
Middle Name
*
Address
*
Street Address
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Phone
Cell Phone
If you would like to receive text messages please circle your carrier
AT&T
US Cellular
Verizon
Email
*
Enter Email
Confirm Email
Birth Date
*
MM
1
2
3
4
5
6
7
8
9
10
11
12
DD
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
YYYY
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Gender
*
Male
Female
Transgender
Non-Binary
Are you an Iowa resident?
*
Yes
No
(lived in Iowa for the past 90 days)
Ethnic Information
(Optional)
Do you consider yourself to be Hispanic/Latino?
Yes
No
In addition, select one or more of the following racial categories to describe yourself
American Indian/Alaskan Native
Asia
Black or African American
Native Hawaiian/Pacific Islander
White
Academic Information
High School
*
Belmond-Klemme
CAL Community
Central Springs
Charles City
Clear Lake
Forest City
Garner-Hayfield-Ventura
Hampton-Dumont
Lake Mills
Mason City
Mason City Alternative
Newman
North Butler
North Iowa
Northwood-Kensett
Osage
Rockford
St. Ansgar
West Fork
West Hancock
Other
High School (other)
*
Please Indicate Your Meta Major
*
-Select Your Meta Major-
Agriculture
Business
Humanities
Human & Public Services
Health Sciences
STEM
Skilled Trades
Anticipated High School Graduation
*
2023
2024
2025
2026
Hidden
Colleges where I have taken other classes
Separate multiple colleges with a ';'
Does your mother have a Bachelor’s Degree (4 year)?
*
Yes
No
Does your father have a Bachelor’s Degree (4 year)?
*
Yes
No
Goal of taking NIACC Classes
*
Transfer
Explore courses
Enter Job Market
Self Improvement
Improve Job Skills
Personal Interest
Change Careers
Undecided
Certificate or Licensure Required
Enrollment Information
Term beginning (Semester)
*
Fall 2024
Course Name
*
(Example: Introduction to Psychology)
Course Number
*
(Example: PSY-111)
Section
*
(Example: W001)
Add another class?
Check to add another class
Course Name
*
(Example: Introduction to Psychology)
Course Number
*
(Example: PSY-111)
Section
*
(Example: W001)
Add another class?
Check to add another class
Course Name
*
(Example: Introduction to Psychology)
Course Number
*
(Example: PSY-111)
Section
*
(Example: W001)
Add another class?
Check to add another class
Course Name
*
(Example: Introduction to Psychology)
Course Number
*
(Example: PSY-111)
Section
*
(Example: W001)
High School Seniors Only
Are you considering NIACC after high school graduation?
Yes
No
If yes, this form will be considered your application for admission.
Please indicate the major you are considering
Will you plan to live on campus?
Yes
No
Family Educational Rights and Privacy Act (FERPA)
*
I hereby authorize NIACC to release information pertaining to test results, school performance, grades (may include unofficial transcripts), attendance records, evaluation, and personal information to my high school and parent/guardian.
Δ
Nondiscrimination Statement
Web Accessibility Statement