New Online Application

Online Application

General Information

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

First Name

Middle Name

Last Name

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

By clicking the box below and providing your phone number, you agree to receive SMS/Text messages, telemarketing calls, including calls made using an automatic telephone dialing system ("autodialer") and/or pre-recorded voice messages, from Pinnacle Career Institute at the phone number provided regarding your interested in our education programs. You understand that your consent is not required to purchase goods or services and you may revoke your consent at any time by replying "STOP" to a text message or calling 816-608-4774.