Student Profile

First Name:*
Last Name:*
Middle Name:
Maiden Name:
Address:*
City:*
Zip Code:*
Birth Date:*
Telephone:*
Email:*
Number of Dependents:*
Gender*
Drivers Lic/ID/Passport No.*
Drivers Lic State:*
SSN*
Have you ever been convicted of a Felony?*
Emergency contact first name*
Emergency contact last name*
Emergency Contact Phone*
Ethnicity Detail:*
Marital Status*
State*

Program Section

Campus of Interest:*
Program of Interest:*
How long have you considered a career in this field ?*
Do you need any special accomodations ?*
If selected yes are you able to provide documentation for your request ?
Do You Have Reliable Transportation?*

Educational Information

High School / GED

Graduated With*
High School Name (if no school, put NA)*
High School Grad Year

College

Graduated*
College School Name:
College Graduation Year:

Why have you choosen to pursue this program?

Student Questions/Concerns

Student Questions/Concerns:*

Future Career And Education Plans

Have you discussed this with your significant other?*
How do your family/ spouse / significant other feel about your educational plans? Do you have their Support*
What are your educational goals?*
Have you done any research on the career you are interested in?*
On a scale of 1 - 10 how would you rate your ability to finish what you start?*

Financial Need Assessment

Have you saved money aside for your education?*
Have you researched financial aid or tuition reimbursement programs to help pay for education?*
Do you have any other source of income you can us e toward your education?*

Employment And Personal Background

What is your work schedule?*
Are you willing to work part - time while you are in school ?*
Do you have child care arrangements if you come to school?*
Why do you feel that you would be a good fit for our program?*
Are you ready to commit yourself to being flexible on your work schedule?*
Are you punctual and manage your time responsibly?*
Are you ready to commit yourself to being flexible on your Clinical schedule?*

Purpose of The Personal Interview

Our approach for evaluating students is different from most schools and is primarily influenced by the following:

  • We have an excellent reputation with the companies that employ our graduates. We seek students who will become graduates that companies want to hire.
  • We seek students who want to graduate. We believe interest, desire, and motivation make the difference between graduate and drop out.

The personal interview is an important part of the process and provides potential applicants/families with:

  • An overview of career choices in many of today's fastest growing career areas.
  • Interview also provides us with an opportunity to evaluate your interest, motivation, academic background, and family support.

Student Benefits

Career Care Institue's student (and their families) receive a number of special benefits designed to help students reach their career goals. These benefits are presented in our Student Catalog. This catalog is designed to show you how our school helps prepare graduates to enter their chosen career fields.

The Application Process

Our program is not for everyone. However, if at the conclusion of this interview it is determined that you are qualified and interested in the program, we will submit this application and begin the enrollment process.

Student Comments

Digital/Type Signature

User Agreement

By checking this box, I understand the information and details shown on this application form. The information that I have provided is accurate and true. The signature/Typed signature above is confirmation that I have completed the application with accurate and honest details.*