CNI Application - CNI College

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This field is for validation purposes and should be left unchanged.

Today's Date(Required)

MM slash DD slash YYYY

Personal Information

First Name(Required)

Last Name(Required)

Nickname(Required)

Address(Required)

Street Address Address Line 2 City State ZIP Code

Cell Phone(Required)

Home Phone(Required)

Email(Required)

Date of Birth(Required)

MM slash DD slash YYYY

Age(Required)

Gender(Required)

Citizenship(Required)

Social Security #(Required)

U.S. Resident Alien No.

Are you a resident of the State of California?(Required)

Yes

If yes, as of when?

Program of Interest(Required)

How did you hear about our school?(Required)

Referred by:

How soon would you be able to start?(Required)

Personal handicap that may affect your job limitations (if any)

As of today, are you:(Required)

Number of dependent children that will receive more than half of their support from you:

Number of other dependents that live with you now, (other than your children or spouse) and that you provide and will continue to provide more than half of their support:

Veteran (U.S.)(Required)

Yes

Currently on Active Duty?

Yes

Housing during enrollment(Required)

Ethnic Group(Required)

Hispanic/Latino

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

Other

This information is required for statistical reporting to IPEDS, a contractor of the USDE.

If Other, please list

Have you ever been convicted of a misdemeanor?(Required)

Yes

Have you ever been convicted of a felony?(Required)

Yes

(If you answer yes to the above two questions, please speak with an Admissions Advisor. The College does not accept admissions applications from prospective students with felony convictions).

Previous Education

Have you completed a U.S. High School or its equivalent?(Required)

Yes

Graduation Date(Required)

MM slash DD slash YYYY

Name of High School(Required)

City

State

Highest educational level completed(Required)

Certificate, Diploma or Degrees earned by the applicant within the USA or ABROAD: (If needed use AACRAO for reference in recognized foreign educational levels)

Last School/College/University Attended(Required)

Country

Last Date Attended

MM slash DD slash YYYY

Financial Aid

Are you interested in applying for Federal Financial Aid(Required)

Yes

Have you received financial aid before?(Required)

Yes

If yes, do you owe a federal refund or have you defaulted on a federal loan?

Yes

Not sure

Registered with Selective Service?(Required)

Yes

(Must be registered to receive Federal Aid, see the FAO for further assistance)

Month/Year Registered(Required)

Miscellaneous Information

Employment History

Current employment status?(Required)

What kind of hours do you work?(Required)

Have any family members ever served in the Military?(Required)

Yes

Relationship(Required)

Support System

Do you have reliable transportation?(Required)

Yes

Have you saved money for school?(Required)

Yes

Do they know you're here?(Required)

Yes

Child care?(Required)

Yes

Who is your best support system?(Required)

I certify that all the information on this form is true and correct to the best of my knowledge. I also understand that if required, I must provide supporting documentation of the information reported.

Applicant's Signature(Required)

Type full name

Date(Required)

MM slash DD slash YYYY