Application For Admission

Applicant Information
Name

First NameLast Name
Date of birth

MonthDayYear
Date
SSN:
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number
Please enter a valid phone number.
Date of Birth

MonthDayYear
Date
Email
example@example.com
Education
High School
Address
GED PROGRAM ATTENDED
Program Name
Date Completed

MonthDayYear
Date
Other Educational Programs (vocational, college etc.)
School Name
Address
Certificate/Degree Obtained
Date Completed

MonthDayYear
Date
How did you hear about Ideal?
Programs:

CompTia A+ certificationCell phone repair specialistWebsite development specialistTelecommunication TechnicianOffice Equipment repair TechniciansEntrepreneurship certificateAdministrative professional with MS officeBusiness AnalystQuick books ProfessionalHSEAPESLOther
Workshops

Social media marketing for BusinessHow to make money on youtubeHow to make money on Ebay and AmazonVideo for web marketingEntrepneurshipBusiness AnalystQuality AssuranceJob readiness
Employment Information (most recent first)
Current Employer
Address
City
Phone
Position
How long?
Email
example@example.com
Fax
State
ZIP
Annual Income
Reason for leaving
EMPLOYER 2:
Employer
Employer address
How long?
City
E mail
example@example.com
Fax
Phone
State
ZIP Code
Position
Hourly Salary (Please circle)
Reason for Leaving
EMPLOYER 3:
Employer
Employer address
How long?
City
E mail
example@example.com
Phone
State
Fax
Position
Hourly Salary
ZIP Code
Annual income
Reason for Leaving
Emergency Contact
Name
Address
City
ZIP Code
Phone
Relationship
Medical/Mental Health History
Do you have a disability?
Does candidate have concerns about your own mental/emotional stability?

YesNo
If yes, please briefly provide details
Does candidate have a history of substance abuse and/.currently involved in treatment?

YesNo
Please list current treatment schedule here
I understand that I will be charged tuition and fees at rates established by Ideal Institute of Technology and published in an addendum to the catalog. The tuition and fees printed may be subjects to change : Ideal Institute of Technology evaluates institutional tuition and fees periodically. Students are legally responsible for all costs incurred at Ideal Institute of Technology. The fees are not covered by financial aid and alternative loans. Further, the institute shall be entitled to recover attorneys and collection agency fees and interest associated with the collection of delinquent account. I certify that the information given in this application is complete and accurate. I understand that withholding or giving false information will makemeineligible for admission or result in immediate dismissal from Ideal Institute of Technology. I understand that all application materials become the property of Ideal Institute of Technology.

Applicant's Signature: (required)
Main Campus 121 S main street, Mays Landing, NJ 08330

Branch Campus 4403 E Black Horse Pike Pleasantville, NJ 08232

www.iitnj.org admissions@iitnj.org
Applicants Signature (required) *

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Date

MonthDayYear
Date
Should be Empty:

Applicant Information

Education

Employment Information (most recent first)

Emergency Contact

Medical/Mental Health History