Online Application

A. Personal Information

First Name:*

Middle Name:

Last Name:*

Email:*

Phone:*

Type of Phone:*
Home Work Cell
Can we text you?

Zip:*

Address:*

Apt./#:

City:*

State:*

Gender:*
Male Female

Birth date:*

Birthplace City:*

Birthplace County:*

Birthplace State:*

List current immigration status, if applicable:

Which immigration status do you intend to hold while enrolled here?:

Citizenship:*
US Citizen US Permanent Resident Other:

Country of Citizenship:*

What race do you consider yourself to be?:*
African American/Black
Alaskan Native or American Indian
Asian
Filipino
Hispanic/Latino(a)
Native Hawaiian or Other Pacific Islander
White
Other/No response

Are you a veteran?:
Yes No

Will you be using VA Benefits, Yellow Ribbon or applying for Veteran's assistance to help cover your tuition?:
Yes No

B. Educational Information

Are you a high school graduate?:*
Yes No

If no, do you have a High School Equivalency (HSE) or equivalent to a high school diploma?:
Yes No

Name of high school where you received your high school diploma, High School Equivalency (HSE) or equivalent:*

High School graduation date:*

C. Department Data

Have you previously enrolled at American Career College?:* Yes No
If yes, when?:

Statement of Disclosure: Have you ever been charged with or convicted of any felony or misdemeanor (other than minor traffic violations) including juvenile charges, drug and alcohol offenses, deferred prosecutions / judgments, or expunged convictions?:*
Yes No

D. Admission Information

Program:*

Campus:*

How did you hear about us:*

I consent to be called by a college representative with information for educational opportunities at the number(s) provided above. I understand calls may be initiated by an automated telephone dialing system. I need not grant this consent to receive information or to be eligible to enroll with ACC. Note: calls may be recorded for quality assurance purposes.

Security and Fire Safety Information - Annual Security Report: American Career College is committed to partnering with students, faculty and associates to create a safe campus community. Information regarding campus security as well as personal and fire safety, that covers topics such as Campus Security Authorities; disciplinary procedures; and crime prevention, reporting, and statistics for the most recent three-year period, is available at americancareercollege.edu/safety-security.html. You may also request a paper copy of the report by sending your request to safetyandsecurity@americancareercollege.edu.

* Required Information