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Nebraska Indian Community College List all colleges, universities, technical and trade schools that you have attended? Specify any previous degree, diploma- certificate- conferred/major: (Please include degrees obtained from Nebraska Indian Community College in list.) Name: ____________________________________________________ City/State: _____________________________ From:___________ To: ___________ Education/Certification/Degree: __________________________________ Name: _____________________________________________________City/State: _____________________________ From:___________ To: ___________ Education/Certification/Degree: __________________________________

**If you intend to transfer current credits held by other institutions to NICC – you MUST request official documentation to be mailed to Registrar at PO Box 428, Macy, NE 68039 What are activities you want to experience in college?_______________________________________________ ____________________________________________________________________________________________________________

________________________________________________________________________________________________ ________________________________________________________________________________________________

Please provide us with one emergency contact:

How did you hear/decided to attend NICC? circle one of the following.

Name: _______________________________________

Convenient Location


Address: _____________________________________

Newspaper ad




NICC Alumni


_____________________________________ Telephone Numbers: Home: ___________________ Cell: ___________________ Work: ___________________

High School Counselor Other ____________________________

Relationship: ________________________________

I certify all the information I have given in this application is complete and accurate to the best of my knowledge, and if admitted, I agree to observe all the rules and regulations of Nebraska Indian Community College. I understand that I am responsible for the information in the current college catalog which can be found online at or through Student Services. I acknowledge that NICC will be allowed to use activity photographs taken of me participating in school events for marketing or other business related purposes. Signature: _____________________________________________ Date: ___________________________________

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