Online Application
Program Selection
In the Program fields below you can select the program related to the Campus of your choice.
Campus
...
FAIRFIELD
ONLINE
RIVERSIDE
SACRAMENTO
WEST COVINA
Required
Program
...
AAS DEGREE SUBSTANCE USE DISORDER COUNSELING-IDL (S-AAS-SUDC-IDL)
ALCOHOL AND DRUG COUNSELING STUDIES - H (S-ADCS-H)
ALCOHOL AND DRUG COUNSELING STUDIES - IDL (S-ADCS-IDL)
MEDICAL ASSISTANT (S-MA-H)
PHARMACY TECHNICIAN (S-PT-H)
AAS DEGREE BUSINESS ADMINISTRATION-IDL (S-AAS-BUS-IDL)
BUSINESS OFFICE ADMINISTRATION-IDL (S-BOA-IDL)
AAS DEGREE CYBER SECURITY - H (S-AAS-CYB-H)
CYBERSECURITY SPECIALIST-H (S-CYB-H)
BEHAVIORAL HEALTH ASSISTANT-IDL (BHA-IDL)
ELECTRICAL TRAINING PROGRAM-H (S-ETP-H)
HVAC TECHNICIAN-H (S-HVAC-H)
Required
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First Name
Required
Middle Name
Last Name
Required
Contact Info
Home Phone
Cell Phone
Required
Personal Email
Required
Email
Required
Address
Street
Required
City
Required
State/Province
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Alabama
Alaska
Alberta
American Samoa
Arizona
Arkansas
Armed Forces
Armed Forces Americas
Armed Forces Pacific
British Columbia
California
Colorado
Connecticut
Delaware
District of Columbia
Federated States of Micronesia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Manitoba
Marshall Islands
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Brunswick
New Hampshire
New Jersey
New Mexico
New York
Newfoundland
North Carolina
North Dakota
Northern Mariana Islands
Northwest Territories
Nova Scotia
Nunavut
Ohio
Oklahoma
Ontario
Oregon
Palau
Pennsylvania
Prince Edward Island
Puerto Rico
Quebec
Rhode Island
Saskatchewan
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virgin Islands
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Yukon
N/A
Required
Zip/Postcode
Required
Personal Information
Birth Date
Required
Social Security No
Required
Gender
...
Male
Female
Another Gender
Required
Ethnicity
...
Asian
Black or African American
Hispanic/Latino
Race and Ethnicity Unknown
White
Native Hawaiian or other Pacific Islander
American Indian or Alaska Native
Two or more races
Non-Resident Alien
Middle Eastern
North African
Required
Residency Status
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US Citizen
Eligible Non-Citizen
Other
Required
Marital Status
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Divorced
Married
Separated
Single
Required
Housing
...
Off Campus
W/parents
Required
Are you a Veteran?
Yes
No
Not Selected
Required
Education
Are you a high school graduate?
Yes
No
Not Selected
Required
Do you have a G. E. D.?
Yes
No
Not Selected
Required
High School Name
City
State
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Highest Level of Education
...
High School Diploma/GED
ATB/ECPP
Previously Attended Some College
Associates Degree
Bachelors Degree
Higher Than Bachelors
Required
EMPLOYMENT INFORMATION
Are you currently employed?
...
Yes
No
Required
Employer/Company Name
City and State
Phone
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Have you applied to InterCoast before?
Yes
No
Not Selected
Required
If yes, When/Where?
Program:
Will you be seeking financial assistance?
Yes
No
Not Selected
Required
Signature
Required
Signature Date
Required
Statement of non-discrimination: InterCoast does not discriminate on the basis of sex, age, handicap, race, natural origin, sexual orientation, political affiliation, creed or religion in its admission to or treatment in its programs and activities, including advertising, training, placement assistance, and employment. The institution follows all policies pertaining to admission of students with special needs such as physical or mental handicaps or learning. Any special accommodation requests, if applicable, must be made in writing. The Campus President is responsible for accepting students and determining whether applicants, including those with special needs, can benefit from the training.
I certify that all the information contained in this application, and in all of the supplemental materials which I shall submit, is accurate and true. I further understand that any submitted records and documents are not returnable. I understand that I may be required to provide supporting documentation of the information reported herein. In connection with my application for tuition assistance, I understand that a consumer report, including financial, credit, criminal, and/or other information. I authorize, without reservation, a credit report to be obtained on my behalf, and authorize the institution or loan servicer to have access to such information to determine eligibility for tuition assistance. I understand the questions contained in this application will be used solely for statistical reporting, admissions, and/or financial consideration. By signing this document electronically, I certify that the information is provided by me and I certify that my electronic signature used on this document is a legally binding equivalent to my handwritten signature.
Enter the above code
Required