Call: 1.800.614.0900


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Please fill out the following application form and one of our admissions representatives will contact you within 48 hours. Thank you for your time.

* indicates required fields

GENERAL INFORMATION
Last Name *
 First Name *

 Middle Initial
Maiden Name (If applicable)
    
Street Address *

 City *

 State *
Country (If other than U.S.)

 Zip Code *
E-mail Address *
Phone *
Day Evening
The best time to call me is:

PERSONAL
Date of Birth
/ /
MM/DD/YYYY		 Driver's License Number
   
Gender:
  Male      Female		  

EDUCATION
I have graduated from
high school:
Yes No		 I am planning to graduate
from high school:
Yes No		 I have received a GED certificate:
Yes No		 I am expecting to receive a GED certificate:
Yes No
If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY		 If Yes, Month/Year
/
MM/YYYY
Name of high school

 City

State

Name as it appears on high school academic records:
Have you applied to THIS institution before?
Yes No
If yes, for which year?

(YYYY)

Have you attended college before?
Yes No

If you have attended college, approximately how long did you attend?
Less than 1 year
1-2 years
2-3 years
3-4 years

Degree received?
Yes No

Extracurricular Activities (such as community or school involvement):

EMPLOYMENT
Current Employer:

 Position:
Duties:
Indicate the number of hours you currently work per week:
Have you set money aside for your education?
Yes No

METHOD OF PAYMENT
I will pay for my entire term charges on or before registration.
I will provide a letter from an authorized company or agency confirming that it will pay my entire charges each term.
I will require financial assistance to help pay my term charges.

Are you a U.S. citizen? Yes No

How did you hear about Pinnacle Career Institute? *

Campus Location: *

  
Program of interest: *

What are you hoping to achieve with your education from Pinnacle Career Institute?

How quickly are you looking to start your career?