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ADMISSIONS CHECKLIST (Ilisagvik College)

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ADMISSIONS CHECKLIST
Required for Admission
Application for Admission
o
Fall Semester: Aug. 7, 2020
o
Spring Semester: Dec. 18, 2020
Request for Transcripts
o Complete form for verification of high school diploma o r
o Contact the State Department, (Donna) at 907.465.4685 for GED transcript
Tribal Status Documentation (for Alaska Native/American Indian
applicants)
o Copy of Tribal Card or
o Shareholder Verification form
Meningitis Form
Required prior to Registration for Classes
Registration form
Placement Testing (ACCUPLACER) (For more information, please email
birgit.meany@ilisagvik.edu
or call 907.852.1818)
Optional
Contract/Application for Housing (Iḷisaġvik provides on-campus, VLQJOH
occupancy dormitory rooms. Applicants must submit an application to the Residential
Center. Contact Student Services, at 907.852.1809.)
Consultation with Financial Aid Manager (Call Nancy Grant at 907.852.1708 or
email fin.aid@ilisagvik.edu for information
.)
For any Admissions related questions, contact Haavale Tuilautala
(907.852.1754) or email registration@ilisagvik.edu.
Please print clearly; complete all fields below Office Use only
Semester (Check one): Spring Summer Fall Year 20 Date Received:
Last Name: First: Middle:
Previous Names:
Date of Birth: SS# Gender: Male Female Other
Mailing
Address
Address
City: State: Zip Code
Email Address: Work Phone:
Home Phone: Cell Phone:
Marital Status: Single without children Single with children Married without children
Married with children
Did your parents/guardians graduate from a four-year college/university? Yes No
Tribal Status if Applicable Shareholder of any Alaska Native Corporation Tribal member
Name of Corporation/Tribe (provide verification)
Ability to speak Alaska Native/American Indian Language None Limited Conversational Fluent
Ethnic Origin
Alaska Native African-American American Indian Asian
Caucasian Hawaiian Hispanic Pacific Islander Other
Alaska Resident (1yr) Yes No
US Citizen
Yes No If no, Nation of Citizenship
Permanent Resident Yes No
Active Military Yes No If no, are you a Veteran? Yes No
Enrollment Status (Check one)
Part-time (1-6 credits) Part-time (7-11 credits) Full-time (12 or more credits)
Housing: I plan to live off-campus I would like student dormitory housing (housing application needed)
Level of Education Completed
Please have transcripts of all past schools attended, including proof of high school graduation or G.E.D. certificate, sent to
Iḷisaġvik.
High School Graduate Date: Name of School:
G.E.D. Completion Date: Site:
Associates Degree Bachelor’s Degree Master’s Degree
Test Taken: Please have test results sent to Iḷisaġvik College, Office of the Registrar
ACCUPLACER ACT SAT Other:
Special Needs/Disability: Please indicate if you will request accommodations. Yes No
APPLICATION FOR ADMISSION
Office of the Registrar/Admissions
P.O. Box 749 Barrow, AK 99723
Phone: 907.852.1754 or 1757
Fax: 907.852.1784
registration@ilisagvik.edu
LIST ANY PRIOR COLLEGES AND/OR UNIVERSITIES ATTENDED BELOW.
Please request an official transcript from each college or university attended.
College/University Name Dates Attended Degree Earned Date of Award


STUDENTS MUST BE ADMITTED TO PROGRAMS TOTALING AT LEAST 30 CREDITS TO RECEIVE FEDERAL
AID
BBA – Bachelor in Business Administration, app. 120 credits Certificate, no level, app. 30 credits
AAS – Associate of Applied Science Degree, app. 60 credits Certificate, Level II, app. 30 credits
AA – Associates of Arts Degree, app. 60 credits Certificate, Level I, app. 15
credits
AS - Associates of Science Degree, app. 60 credits Endorsement, app. 5-12 credits
CHOOSE
ONE
(1)
MAIN
CATEGORY
AND
SELECT
PROGRAMS
IN
THAT
CATEGORY
*Denotes programs with special restrictions; students should check with the Admissions Officer
Accounting Business Management Information Technolog
y
Certificate, Accounting Technician I
Certificate, Bus Specialist I
Endorsement, Office Productivity
Certificate, Accounting Technician II
Certificate, Bus Specialist II
Certificate, Data Analysis I
AAS, Accounting
Certificate, Entrepreneur/Small Bus Mgmt I
Certificate, Data Analysis II
Allied Health
Certificate, Entrepreneur/Small Bus Mgmt II
Certificate, Digital Arts in the Arctic I
Endorsement, Dental Assist. Trainee
AAS, Business and Management
Certificate, Digital Arts in the Arctic II
Certificate, Allied Health
BBA, Business Administration
Certificate, Info Tech Supp Specialist II
Certificate, Medical Coding Specialist
Dental Health Therap
y
Certificate, Info Tech Supp Specialist II
AAS, Allied Health
Certificate, Dental Health Aide*
A
A
S
, Information Technology
AA, Human Services (Emphasis)
AAS, Dental Health Therapy*
Indigenous Education
Construction Trades Heavy Truck/Equip Operations
Certificate, Indigenous Education I
Endorsement, Building Maintenance
Endorsement, Heavy Truck Operations*
Certificate, Indigenous Education II
Endorsement, Carpentry, Level I
Endorsement, Heavy Equip Operations* AA, Indigenous Education
Endorsement, Construction Mgmt
Industrial Safety
Liberal Arts
Endorsement, Electrical, Level I
Endorsement, Industrial Safety Level I
Certificate, Liberal Arts
Endorsement, Pipefitting, Level I
Iñupiaq Studies
AA, Liberal Arts
Endorsement, Pipeline Insulation, I
Certificate, Iñupiaq Fine Arts
Office Management
Endorsement, Plumbing, Level I
Certificate, Iñupiaq Language I
Certificate, Office Management I
Endorsement, Scaffolding, Level I
Certificate., Iñupiaq Language II
Certificate, Office Management II
Endorsement, Welding Materials Tech
AAS, Iñupiaq Studies
AAS, Office Management
Certificate, Construction Technology I
AAS, Office Management (Medical)
Certificate, Construction Technology II
Tribal Doctor
AAS, Construction Technology
Certificate, Tribal Doctor I
Certificate, Tribal Doctor II
Applicant Disclosure:
I hereby certify that the information furnished in this application is true and complete to the best of my knowledge. I
understand that false or misleading information provided herein may lead to my suspension or expulsion. I agree to abide by
all Iḷisaġvik College policies upon enrollment.
Applicant Signature Date

GuardianSignature(ifapplicantisunder18) Date
APPLICATION FOR ADMISSION
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signature
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Office of the Registrar/Admissions
P.O. Box 749; Barrow, AK 9723
Phone: 907.852.1754 or 1757
Fax: 907.852.1784
HIGH SCHOOL TRANSCRIPT
REQUEST
Student Name
First Middle Las
t
SS#
Former Name(s)
Birthdate
Email Address
Educational Institution Where You Earned Your High School Diploma
Name
Address
Phone Fax
Date of Graduation
Date Last Attended
Please send a certified official high school transcript record to:
Office of the Registrar/Admissions
Iḷisaġvik College
P.O. Box 749
Barrow, AK 99723
Signature:
Date:
** To request GED, please contact Donna Collins (907) 465-4685 or (907) 465-4186 or email
her at donna.collins@alaska.gov
SHAREHOLDER AUTHORIZATION TO RELEASE INFORMATION
Dear Student/Participant:
Iḷisaġvik College is an accredited institution and one of 37 Tribal Colleges nation-wide. As a federally recognized
Tribal College, the College receives some of its funding from the federal government and must provide proof
that a certain percentage of the student body is American Indian or Alaska Native. Your information serves only
to verify that Iḷisaġvik College meets that criterion.
Thank you.
Birgit Meany, Ed.D.
Dean of Instruction
By completing the informational items below, I hereby authorize the corporation indicated below to provide
Ilisagvik College with a verification of my enrollment as a shareholder.
Ahtna, Incorporated Aleut Corporation
Arctic Slope Regional Corporation Bering Straits Native
Corporation
Bristol Bay Native Corporation Calista Corporation
Chugach Alaska Corporation CIRI
Doyon, Limited Koniag, Inc.
NANA Regional Corporation SEALASKA
Other:
FirstName(Print) LastName(Print) SocialSecurity# DateofBirth
SignatureofShareholderand/or(CustodianofRecordforMinor)
Date
PhoneNumber E‐mailaddress
MENINGITIS

Know Your Risk – Learn about Vaccination
Important
No
t
ice
:
Information
in this
handout
has been gathered from the Alaska
Postsecondary
Student
Immunization
Act (HB185),
signed into law effective May 18, 2005. Additional
information
was gathered from the Alaska
Department
of
Health and Social Se
r
vi
ce
s
'
Division of Public Health and the Web site of the
American
College Health Association
at
http://www.acha.org/projects_programs/meningitis.
The Alaska Commission on
Postsecondary Education
(ACPE) cannot provide medical
information
and is not
r
es
p
o
n
si
b
le for any medical
information
provided to
schools or to students. For questions specific to meningitis,
immunization,
and related diseases, please consult a
qualified medical
p
r
of
e
ssio
na
l.
Did you
kn
ow
?
•
Meningococcal disease is a contagious but largely preventable bacterial infection that most often leads to
meningitis, an inflammation of the membranes surrounding the brain and spinal cord, or a condition called
meningococcal septicemia, which is an infection of the blood.
・ Meningococcal disease is caused by bacteria called Neisseria meningitides that are spread person-to-person
through the air (usually by sneezing or coughing), through direct contact with an infected person, such as oral
contact with shared items like cigarettes or drinking glasses, or through intimate contact, such as kissing. This
disease is not as contagious as things like the common cold or the flu, and it is not spread by casual contact
or by simply breathing the air where a person with meningitis has been.
・ Meningococcal disease is a
se
r
io
u
s illness that can lead to death within a few hours of onset; one out of ten cases is
fatal, and in one out of seven survivors it can lead to severe and permanent disabilities, such as brain damage, hearing
loss, seizures, or limb amputation.
What are the symptoms of meningococcal
d
ise
a
se
?
•
High fever, headache, and stiff neck are common symptoms of meningitis in anyone over the age of 2 years. A rash
may also develop over parts of the body, or the entire body. Other symptoms include nausea, vomiting, discomfort
looking into bright lights, confusion, and sleepiness. These symptoms can develop over several hours, or they may
take 1 to 2 days. As the disease progresses, seizures may develop. If you notice these symptoms – in yourself, friends,
or others – you should contact your college health service or local hospital immediately.
Who is at risk for meningococcal
d
ise
a
se
?
•
Anyone can get meningococcal meningitis, but scientific evidence suggests that collegefreshmen living in
campus housing are at moderately increased risk to get this disease when compared to the general college population.
The reasons for this increased risk are still not known for certain, but factors may include such things as crowded living
situations, bar patronage, active or passive smoking, irregular sleep patterns, and sharing personal items.
•
Other risk groups include infants and young children, household contacts to a person with meningococcal disease,
refugees from parts of the world with high rates of meningococcal disease, laboratory workers who work with this
bacteria, and military recruits.
Are there vaccines against meningococcal
d
ise
a
se
?
•
Yes, there are two safe and effective vaccines that protect against four strains of the bacteria that cause
meningococcal disease – serogroups A, C, Y, and W135. Immunization against meningococcal disease will decrease
the risk of contracting the illness from these meningococcal strains.
How can meningococcal disease be
p
r
eve
n
t
e
d?
•
Many cases of meningococcal disease can be prevented. The Centers for Disease Control and Prevention and
the American College Health Association recommend that all first-year students living in residence halls be
vaccinated against meningococcal disease. All other college students under the age of 25 years who wish to reduce
their risk for the disease may choose to be vaccinated.
•
Vaccination is safe and effective. It protects against four of the five most common strains (or types) of bacteria that
cause meningitis. Approximately 70 to 80 percent of cases in the college age group are caused by strains that
are potentially vaccine-preventable. The most commonly reported adverse reactions among adolescents and adults
in clinical studies were pain at the injection site, headache, and fatigue. These respond to simple measures
(ibuprofen or acetaminophen) and resolve spontaneously within a few days.
More
I
n
fo
r
m
a
t
io
n
To learn more about meningitis and immunization, visit the websites of the American College Health Association,
www.acha.org/meningitis, and the Centers for Disease Control and Prevention,
www.cdc.gov/ncidod/diseases/submenus/sub_meningitis.htm
.
I have received a copy of this notice on meningococcal disease.
I have received an immunization against meningococcal disease.
Student Name
Student Signature Date
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Completed 25 July 2020

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