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Intent to Return Re-Application Form


The following online application for re-admitting students is forwarded as an email message to Itasca Community College. This form should only be completed by students who have attend classes in the past or applied for admissions and paid the $20 application fee, but never attended. This form may take five to ten minutes to complete.



Application to Itasca Community College is granted without regard to race, creed, color, sex, age, national origin, or handicap. This institution abides by the provisions of Title IX, federal legislation forbidding discrimination on the basis of sex, and by all other federal and state laws regarding equal opportunity. Alternative formats of this application are available upon request.

Application for: of


Full Name:



Maiden Name:

Social Security #:
(Optional)		 Many colleges/universities use Social Security numbers for student identification purposes on student records. Providing your Social Security number is voluntary. If you do not provide this number, your application will still be processed. This data is requested for purposes of administration, program evaluation and consumer and alumni data. Your number also may be used to create summary information about MnSCU programs through data matches with other state agencies.
Date of Birth:
(Optional)		 Either SSN or Date of Birth is needed to make sure we can properly access the correct record.



Permanent Address Information

Address:

City:

County:

State:

Zip:
Is this your present address? Yes No


Present Address Information

Address:

City:

County:

State:

Zip:


Phone Number

Home:

Cell Phone:

email:

 Required





Dates of ICC Attendance:
Please list any college, university, or technical school attended:
School(1):
City: State:
Date: Credits Rec'd:
School(2):
City: State:
Date: Credits Rec'd:
School(3):
City: State:
Date: Credits Rec'd:


Will you be: Full TimePart Time

Your anticipated major field of study:


Class Act
Practical Nursing
RN Transfer
Natural Resources Please check the option that interests you the most:
Forestry
Law Enforcement
Geographic Information Systems
Wildland Fire Fighting

Possible career occupation:


Have you served in the U.S. armed forces?YesNo
Date from: Date to:

Are you eligible for the G.I. bill?YesNo




Application to Itasca Community College is granted without regard to race, creed, color, sex, age, national origin, or handicap. This institution abides by the provisions of Title IX, federal legislation forbidding discrimination on the bases of sex, and by all other federal and state laws regarding equal opportunity. Alternative formats of this application are available upon request.

NOTE: Please click the submit button only once. It may take up to 2 minutes to process the form.

or

Itasca Community College
1851 East Highway 169, Grand Rapids, MN 55744-3397
1-800-996-6422 or 218-322-2300
Fax: 218-322-2332

We Are An Equal Opportunity Educator and Employer
This document is available in alternate formats, 218-322-2433
© 2008 Itasca Community College


A member of the Minnesota State Colleges and Universities