IITNJ Financial Assistance Intake Form

  • Ideal Institute of Technology Financial Assistance Application Form

  • Today's Date*
     / /
  • Date Of Birth
     - -
  • Gender*

  • Current Address

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Contact Preference*
  • Ethnic Heritage?*
  • Race*
  • Marital and Family Status (choose all that apply)*
  • Household
  • Employment Status *
  • If you are employed, are you working:
  • If you are unemployed and a homemaker, are you:
  • School Status*
  • Education Level
  • Post Secondary/ Vocational/ Associate/ High School Plus
  • Housing *
  • Are you a US Citizen?*
  • Do you have any disabilities?*

  • If you chose yes, please ask the Enrollment Specialist for Form D at the booking of your appointment. All infomation you provide is kept confidential. 

  • Migrant Seasonal Farmworker

  • Are you a Migrant Seasonal Farmworker*
  • If you are a migrant seasonal farmworker, choose all that apply:

  • Public Assistance

  • Are You On Public Assistance
  • If Yes, Choose One

  • Military Section

  • Selective Service
  • Military Service *
  • If you chose yes, use DVOP Checklist

  • List start and end dates for active service if applicable

  • Start Date
     - -
  • End Date
     - -
  • Are you disabled?
  • Are you receiving veteran's benefits or assistance?
  • If you are the spouse of someone in the military, are you:
  • If you're an active duty spouse, has your income been affected by spouse's deployment?

  • Offender Status

  • Do you have a criminal background? *This will not affect eligibility**

  • Employment Preferences

    The next couple of questions will help our Career Services Department assist you with job placement. Please answer the following questions as if you're applying for a particular job and specifying the type of job you desire, how much you want make, etc...
  • What type of position do you desire? (Check all that apply)
  • Which employment duration do you desire? (Check all that apply)
  • Are you willing to work any shift?
  • If you check no, which shifts do you prefer? (check all your preferences)
  • Date Available to Work
     / /
  • How many miles is acceptable to work from where you live?

  • Work History

    Current/Last Employer
  • Start Date *
     / /
  • End Date *
     / /
  • Reason for Leaving*

  • If you wish to provide additional work history, inform Enrollment Specialist at the time of your appointment.

  • Certificate/Special Licenses

  • Date Issued
     - -

  • Drivers License

  • Do you have a license*
  • License Type
  • I have access to
  • Transportation (Select all that apply)
  • Endorsements

  • I attest that the information provided is true and accurate. Any misrepresentation may be grounds for termination from program(s).
    I also understand that being eligible for services and/or training does not necessarily entitle me to service/training.

  • Today's Date*
     / /
  • Today's Date
     - -
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