Apply Today Making Careers Possible Breaking Cycles of Poverty Providing Jobs & Revitalizing Communities ICC College Program Application Step 1 of 2 50% Personal InformationYour Name(Required) First Last Your Email Address(Required) Enter Email Confirm Email Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Your Phone(Required)Birthdate(Required) Month Day Year Emergency ContactsName(Required) First Last Phone(Required)Relationship(Required) Name First Last PhoneRelationship Professional References (Employer, Teacher, Pastor, Community Leader)Name(Required) First Last Phone(Required)Email(Required) Name First Last PhoneEmail Education ExperienceSchool(Required) City(Required) State(Required) Academic Status(Required) Currently Enrolled in High School Graduate GED Have you earned any College Credits?(Required)NoYesIf so, how many College Credits?(Required) College(Required) I certify that the information provided is true to the best of my knowledgeSignature(Required)Name(Required) Date(Required) Month Day Year AboutExplain why you would like to be a student at Impact Career Center(Required)What career field are you interested in studying? Why?(Required)List any challenges that may interfere with your progress in the program:(Required)What academic areas are you strongest in?(Required) What academic areas are you weakest in?(Required) What jobs have you had in the past?(Required) CommentsThis field is for validation purposes and should be left unchanged.
