*First Name: MI

*Last Name:

*Street Address (e.g. 123 Celebrate Lane):

Street Address Line 2, if needed (e.g. Apt. 27, Suite B):

*City:

*State: Select below AL - Alabama AK - Alaska AZ - Arizona AR - Arkansas CA - California CO - Colorado CT - Connecticut DE - Delaware FL - Florida GA - Georgia HI - Hawaii ID - Idaho IL - Illinois IN - Indiana IA - Iowa KS - Kansas KY - Kentucky LA - Louisiana ME - Maine MD - Maryland MA - Massachusetts MI - Michigan MN - Minnesota MS - Mississippi MO - Missouri MT - Montana NE - Nebraska NV - Nevada NH - New Hampshire NJ - New Jersey NM - New Mexico NY - New York NC - North Carolina ND - North Dakota OH - Ohio OK - Oklahoma OR - Oregon PA - Pennsylvania RI - Rhode Island SC - South Carolina SD - South Dakota TN - Tennessee TX - Texas UT - Utah VT - Vermont VA - Virginia WA - Washington WV - West Virginia WI - Wisconsin WY - Wyoming Other overseas location *Zip Code:

*Phone Type Mobile Home Work *Telephone number: Extension (if needed)

Best time of day to reach you: 

Early morning before work (6:30 to 8:30)        Morning (8:30 to 12:00)    
Afternoon (12:00 to 5:30)     Evening (5:30 to 9:00)

*E-mail You Prefer to Use: Personal Work Other *E-mail address:

**Work E-mail: Work *E-mail address:

How did you find out about us?

*Are you affiliated with one of our clients? (Important - please select one): Select one from this list D8ER Coast Guard Auxiliary USCG USCGR UC Mil Prgm Div MS Army Natl Guard TN Housing Stability & Education Success BenefitHub Boatman Automotive Restoration & Repair Diebold Nixdorf Amazon Bright Future Training Center EANGUS ARNG ANG NGB Henderson Hall USMC HQ USMC USMCR VA VR&E VA VBA Yum Brands KFC Pizza Hut Taco Bell SERDI UNIVentures Tex-X Retirement Svcs Electronic Solution Krempl Communications Hardees TGI Fridays Baskin Robbins Krispi Kreme Other No, I am not affiliated with a client listed

If you are not affiliated with one of our clients, please enter here how you heard about us:

*Important: Please enter the name of the organization where you work (if not on the list above)
(More than a thousand organizations have had their professional training evaluated for college credit in the past. We'll check the list to see if yours is one.)

*Please enter your Employee Identification Number:
(Note: This is required for USCG Auxiliary member, as well as Diebold Nixdorf and other clients. Your Employee ID Number will be used as your Student ID number in Degree Quest ® . As you can see by the padlock on our web address above, this is a secure website.)

*Does your organization provide tuition benefits to employees?: Select below Yes - Tuition Reimbursement Yes - Up-Front Tuition Assistance Scholarship programs for select colleges No, not at this time I don't know
If yes, what is the annual cap on employee tuition benefits:

Your Academic Goal:

*Current level of education: Select one Need to complete high school High school graduate Vocational Technical College Completed some college courses Earned an Associate's Degree Earned a Bachelor's degree Completed some graduate courses Earned a Master's degree Earned a PhD, EdD or similar degree

*Degree goal: High School Completion Undergraduate Certificate Associate's Degree Bachelor's Degree Graduate Certificate Master's Degree Doctorate Degree (using federal student aid)

*Major: In what subject or field of study are you most interested:

College Credit From Colleges and Universities:

*Have you completed college courses in the past? Yes or No

If you attended college, but haven't earned a BA/BS, how many credits have you earned?
Type: Semester Hours Quarter Hours

*Are you currently pursuing a degree at a college?  Yes or No

• If the answer is yes, which college?
• What degree are you pursuing?
  

If you have already earned a degree, what degree have you earned?

If not yet enrolled, are you interested in pursuing a particular degree at a college?  Yes or No

• If the answer is yes, which college?
• What major or degree do you want to pursue?

*Have you ever served in the military?  Yes or No . . . If Yes, thank you for your service to this nation in uniform!

• If the answer is Yes, in which branch of the military: Army Navy Air Force Marine Corps Coast Guard Army Reserve Army National Guard Navy Reserve Air Force Reserve Air National Guard Marine Corps Reserve Coast Guard Reserve Coast Guard Auxiliary
• Current status: Veteran, Now Separated From the Military Retired Military Active Duty Military Reservist Called to Active Duty Currently Serving in the Ready Reserve Currently Serving as a USCG Auxiliarist
• Highest Pay Grade: E1 E2 E3 E4 E5 E6 E7 E8 E9 W1 W2 W3 W4 W5 O1 O2 O3 O4 O5 O6 O7 O8 O9 O10 GS GM WG Aux Mbr FSO VFC FC VCDR DCDR DCAPT DCOS DCO DNACO VNACO NACO

*(USCG Aux) Flotilla Number:

*Other Non-Traditional Credit: There are other ways in which people earn college credit. Let us know if any of these apply to you:

Have you ever passed a national college level examinations (AP, CLEP, DSST, TECEP, ECE or UExcel) If so, we need to know the test titles and scores.

Have you ever earned professional certification/licenses (FAA Airframe & Powerplant, Automotive Service Excellence, Microsoft, etc.) If so, let us know.

Have you attended professional training through a corporation or government agency. If so, send us the course completion certificates.

FOR ALL: Amplifying information: We need to know about your needs, goals, and desires. Examples of needs, goals and desires you may want to present in the space below may include that you need to keep the costs for the degree as low as possible, or perhaps you desire to finish the degree as quickly as possible, and your goal is to earn a degree in one field of study, but may want to explore a different field of study as you make your decision. This space is yours, so use it to communicate with our counselors providing you with this support:

How to submit this form:  By submitting this form, if you are a prospective student, you are agreeing to the terms of use.

When you press the submit button below, your computer will clear the information from the fields above.  This means that the information has been successfully uploaded to our system. You are then ready to continue with the steps below.

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