Iowa Lakes Community College
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IOWA LAKES > Admissions > Admission Procedures > Online Application (Regular Credit Classes)  

This form must be submitted to apply for admission to any credit granting program at Iowa Lakes Community College. 
There is no application fee. If submitting an application by mail, please type or print all answers.
 PERSONAL INFORMATION
Social Security Number:   
Email Address: (Required)
Legal Name:  Last    First 
Middle Initial   Previous or Maiden Name 
Permanent Mailing Address:  Street  
 City      State        Zip 
County     
Country (if other than the US):
 

Gender:   Male             Female
Driver's License Number: State issued in:  
 Birth date:  
Home Phone:  
Cell Phone:  

Person to contact in case of emergency:
Street    City      
 State       Zip
Phone:  
 Relationship:  Father      Mother       Spouse       Other 

Ethnic Background:
(Optional - please check)
Asian or Pacific Islander
 American Indian or Alaskan Native
 Black Non-Hispanic
 Hispanic
 White Non-Hispanic
 Other
 
 ENROLLMENT
Housing:  Do you wish to receive information about housing at Iowa Lakes? Yes    No
 
 Student Services:  Do you wish to receive information about: 
Tutoring? Yes    No   Financial Aid? Yes    No   

Are you a Dislocated Worker?  Yes    No

I plan to begin college:  Year     Fall         Spring      Summer

I plan to attend classes in:
 Algona  Emmetsburg   Estherville   Spencer   Spirit Lake    Other 

Status: 
Full time     Part time     Evening     Weekend     Other 

Programs (Choose only one.)

Nursing Program Applicants (Choose one)

 

Last High School Attended:
Address City State  
Dates Attended

Educational Background: (Mark only one.)
 Currently in high school.  Expected year of graduation:
Non-high school graduate; did not receive GED
 High school graduate - year of graduation
Non-high school graduate; did receive a GED.
      School/Agency Awarding GED
      Address Dates
 
Attended another college    Yes  No

Colleges and universities attended other than Iowa Lakes.  Please list below:

       Name

Address

Dates Attended

Highest Degree Received
1.   
2.   


       
 TRANSCRIPTS ACT
Please request copies of your high school, college and/or GED transcripts be sent to Iowa Lakes.
 Have you taken college credit courses at Iowa Lakes?
   Yes  No
If yes, where?
What program were you in?
Last date you attended Iowa Lakes
 		   Please send ACT results to Iowa Lakes.
 
 Iowa Lakes ACT code numbers are:
 Emmetsburg 1308     Estherville 1310
 
 I have taken the ACT.
 I plan to take the ACT.
 I do not plan to take the ACT.
 
 RESIDENCY
To determine residency for tuition, please click yes or no:
Are you a resident of Iowa? Yes   No
Have you lived in Iowa the last consecutive 90 days? Yes   No
Do you have an Iowa driver's license? Yes   No
Is your car registered in the State of Iowa? Yes    No
Are you a United States citizen? Yes   No
Are you a lawful permanent resident? Yes   No
Do you have a green card? Yes   No
  (Note: If "yes" please provide us with a copy)
 
 STUDENT TYPES

Student Types (Choose all that apply)
Career Academy Special Needs (COC)
College Prep (H.S.) Talent Search
Drug Free Schools (H.S.) Tech/Prep
Postsecondary (H.S.) Upward Bound
S.A.V.E. Other  
   

 OTHER INTERESTS
Please check areas you would like to receive more information on:
 
Athletics    
Baseball Men's Basketball Women's Basketball
Cross Country (M & W) Golf (M  & W) Softball
Soccer (M & W) Volleyball (W) Wrestling
     
Student Activities    
Intramurals Music (Band) Music (Vocal)
Newspaper Student Senate Theatre
Honors Dorm Honors Program Other 
     
I may need help in...    
Career Planning Counseling Financial Aid
Scholarships Tutoring Other 
     
 

 GOALS

Purpose/goal in attending is to: (Choose ONE)

Transfer to another college/university
 Prepare to enter the job market
 Prepare to change careers
 Improve skills for present job
 Meet certification/licensure requirements
 Explore courses to decide a career
 Self improvement/improve basic skills
 Personal interest
 Undecided / Unknown
 PUBLICITY
How did you first learn about Iowa Lakes?
We would like to notify your hometown newspaper of your acceptance and any honors you may receive.  I give my permission for Iowa Lakes to provide the following information:
Newspaper Name: 
Newspaper Address:
City      State        Zip 
Your parents' names:
 

 RELEASES

Iowa Lakes has my permission to share educational information with any school which I previously attended.
Yes      No

A student must be enrolled as a regular student in an eligible program for the purpose of obtaining a degree or diploma in order to receive financial aid or scholarships. I have read all parts of the form and accompanying instructions. I certify that all information I have supplied on this application and my supporting documents is true.
 
 Name/Signature:    Date:  

You may choose to submit this application electronically, or by mail, to the location you plan to attend:

Iowa Lakes Emmetsburg Campus
3200 College Drive
Emmetsburg, Iowa 50536		 Iowa Lakes Estherville Campus
300 South 18th Street
Estherville, Iowa 51334		 Iowa Lakes Spencer Campus
1900 Grand Ave. Suite B-1
Spencer, Iowa 51301

Send Algona Campus or Spirit Lake Campus to Emmetsburg Campus address.

It is the policy of Iowa Lakes Community College not to discriminate on the basis of gender, race, national origin, creed, age, marital status, disability or any other characteristics protected by applicable law in its educational programs, activities, or employment policies as required by Title VI and VII of the 1964 Civil Rights Act, Title IX of the 1972 Educational Amendments, Section 504 of the Federal Rehabilitation Act of 1973 and the Americans with Disabilities Act of 1990.
 
Welcome to Iowa Lakes Community College

Copyright © 1996 - 2009 by Iowa Lakes Community College. All rights reserved.
Campuses in Algona, Emmetsburg, Estherville, Spencer and Spirit Lake.
If you would like us to mail you information, please complete this request form. 
Questions or comments? Please email us at info@iowalakes.edu or call (712) 362-2604 or 1-800-521-5054.
Equal Opportunity Statement