New Online Application

General Information

Please use your legal name as it appears on your social security card.

First Name

Middle Name

Last Name

Email

Social Security No

Birth Date

Program

Demographics

Ethnicity

Gender

Residency Status

I am 24 years of age or older

Yes No Not Selected

Do you have children?

Yes No Not Selected

Marital Status

Preferred Method of Communication:

Living Arrangements

Street

City

State/Province

Zip/Postcode

Home Phone

Cell Phone

Post-Secondary Education

Proof of Graduation Type

Highest Level of Education

HS Graduation Date

Previous College

Yes No Not Selected

Military Experience

Do you intend to use Military Education Benefits?

Yes No Not Selected

Are you active military or a veteran of the US Armed Forces?

Student Signature

I hereby certify that I have completed the preceding forms, that the information I have provided is true and accurate to the best of my ability, and I wish to sign electronically.

Date

Signature

In connection with my application to Pinnacle Career Institute, I understand that a consumer report that may contain public records information is being requested. This report may include the following types of information: names and dates of previous employers, credit information, etc. I further understand that such report may contain public record information containing my credit, bankruptcy proceeding, etc. from federal, state, and other agencies that maintain such records.