1. technology and computing
2. consumer electronics
3. tv and video equipment
4. dvrs and set-top boxes

Start Date: _____________
Daytime Application
MUSKOGEE
CAMPUS
(Please print clearly when completing application)
Date of Application: _____________
Total Score:___________
Name:____________________________________________________________________________________
(First)
(MI)
(Last)
Mailing Address:____________________________________________________________________________
(Address)
(City)
(State)
(Zip)
Home Phone:_____________ Cell Phone: ____________ Email:____________________________________
Emergency Contact:
____________________________________________________________
(Name)
(Relation)
(If selected as an ICTC student, please circle your t-shirt size)
S
M
L
XL
2XL
(Phone)
3XL 4XL
STUDENT INFORMATION RELEASE APPROVAL: This is an authorization for the local school district to release to Indian
Capital the student records, including confidential records, concerning my son/daughter as they relate to determining
appropriate enrollment. I hereby give approval to have my son/daughter attend ICTC once placement is determined.
Transcript
________________________________________________
Signature of parent/guardian
______________
Date
______________________________________________
Signature of applicant
_____________
Date
Assessment Results
Entered into System
To Be Completed By High School Students Only
Name of High School: __________________________ Current Grade Level:_____ Date of Birth:_________
Father/Guardian:_______________________________________________________________
(First Name)
 Senior Scholarship  GED/Diploma

Financial Aid
Acceptance Notification

PLAN: _____________
(Last Name)
(Place of Employment)
___________________________________________________________________________
(Home Phone)
(Cell Phone)
(Work Phone)
(E-Mail Address)
Mother/Guardian: ______________________________________________________________
(First Name)
(Last Name)
(Place of Employment)
___________________________________________________________________________
(Home Phone)
(Cell Phone)
(Work Phone)
(E-Mail Address)
To Be Completed By Adult Students Only
Are you seeking financial aid? No Yes
If you are seeking financial aid from any of the agencies such as
WIA, TANF, VA, BIA, or Voc-Rehab, please list the agency and the
counselor’s name: _____________________________________
Do you have a High School diploma? No Yes
Do you have a GED? No Yes; year_______________
Do you have educational records
under any other name (i.e. maiden name)? No Yes If yes, what name: ___________________________
List other schools attended: __________________________________________
(School)
GPA:___________
 AM  PM Full Time
Career Major:____________________________________________
10 11 12 Adult
(At time of entry)
9
_________________________________
Home School
_____________________________________________________
Last Name
First Name
To Be Completed By ICTC Staff
2015-2016
__________________________________________
(School)
___________
(Year)
___________
(Year)
Have you ever attended ICTC as a post-secondary day student? No Yes If yes, year __________
2403 N. 41st Street East, Muskogee, OK 74403-1799 P: 918-687-6383 F: 918-686-8984 www.ictctech.com
Choose a Career Major from the following options:
Auto Collision Repair
Drafting
Collision Repair Technician
CAD Technician Mechanical
Auto Service
Technology
Electricity
Electrician’s Assistant
Automotive General Service
Technician
Graphic
Communications
Business, Management &
Administration
Executive Administrative Assistant
Medical Office Assistant
Medical Insurance Coder
Graphic Artist & Printing
Production Technician
Health Careers
Certification
Long Term Care/Home Health
Care Assistant (HS only)
Carpentry
Residential/Commercial Carpenter
Enterprise Network Associate
Machine Tool
Manufacturing Technician
Sports Medicine
Fitness Specialist (HS only)
Student Athletic Training Aide (HS only)
Physical Therapy Aide (HS only)
Service Careers
SC Building & Grounds Maintenance
Technician’s Assistant
Welding
Cosmetology
Heating, Ventilation,
& Air Conditioning
Cosmetologist (HS only)
Residential HVAC Technician
Culinary Arts
Hospitality & Lodging
Management
Culinary Hospitality Assistant
Information Technology
Pipe Welder
Structural Welder
Hospitality Manager
I am interested in the following career major and would like to discuss it with an ICTC counselor:
1st Choice _______________________________________
I prefer to attend:
_____AM (8:10 – 11:05)
2nd Choice ______________________________________
_____PM (11:55 – 2:45)
_____Both (8:10 – 2:45)
Which of the following influenced your decision to attend ICTC?  Tech Fest
 Friend
 Relative  Counselor
 ICTC Catalog
 ICTC Website
 Newspaper Advertisement  Other (please specify) ______________________
Notice:
Completion of this application by itself does not constitute admission to Indian Capital Technology Center.
Please attach the following information to this application for it to be considered complete.
High School Checklist
Adult Checklist




 High School Transcript or GED
 Keytrain Results or Accuplacer Results
(Contact ICTC for testing schedule)
 Interest Inventory
High School Transcript
Attendance Record
PLAN Test Result
Interest Inventory
An interview to discuss placement will be scheduled upon receipt of the completed application.
Adults Only: After placement in an ICTC career major: If you have disabilities which require reasonable accommodations to perform the essential skills of
the career major, it is your responsibility to provide documentation and to notify your instructor or the student services coordinator.
Non-Discrimination Statement: Indian Capital Technology Center is an equal opportunity institution in accordance with civil rights legislation and does not discriminate on the basis of race,
color, religion, national origin, sex/gender, age, marital or veteran status, or disability in the operation of its educational programs, activities, recruitment and admission practices. Concerns
regarding this policy should be addressed to Sharon Billings, District Compliance Coordinator, at 918-687-6383 or 1-800-375-8324, 2403 N. 41st Street E, Muskogee, OK 74403. Additionally,
each campus has a contact in which complaints can be reported.
2403 N. 41st Street East, Muskogee, OK 74403-1799 P: 918-687-6383 F: 918-686-8984 www.ictctech.com
NAME
SCHOOL
DATE
CAREER CLUSTERS INTEREST SURVEY
Circle the items in each box that best describe you. You may make as many or as few circles in each box you choose. Add up the
BOX 5
BOX 4
BOX 3
BOX 2
BOX 1
number of circles in each box. Look to see which three boxes have the highest number.
Activities that describe what I like to do:
• Learn how things grow and stay alive.
• Make the best use of the earth’s natural resources.
• Hunt and/or fish.
• Protect the environment.
• Be outdoors in all kinds of weather.
• Plan, budget, and keep records.
• Operate machines and keep them in good repair.
Activities that describe what I like to do:
• Read and follow blueprints and/or instructions.
• Picture in my mind what a finished product looks like.
• Work with my hands.
• Perform work that requires precise results.
• Solve technical problems.
• Visit and learn from beautiful, historic, or interesting
buildings.
• Follow logical, step-by-step procedures.
Personal qualities that
describe me:
• Self-reliant
• Nature lover
• Physically active
• Planner
• Creative problem solver
School subject that I like:
• Math
• Life Science
• Earth Sciences
• Chemistry
• Agriculture
Total number
circled in Box
1
Personal qualities that
describe me:
• Curious
• Good at following directions
• Pay attention to detail
• Good at visualizing
• Patient and persistent
School subject that I like:
• Math
• Drafting
• Physical Sciences
• Construction Trades
• Electrical Trades/Heat,
• A/C & Refrigeration/
Technology Education
Total number
circled in Box
2
Activities that describe what I like to do:
• Use my imagination to communicate new information to
others.
• Perform in front of others.
• Read and write.
• Play a musical instrument.
• Perform creative, artistic activities.
• Use video and recording technology.
• Design brochures and posters.
Personal qualities that
describe me:
• Creative and imaginative
• Good communicator/good
vocabulary
• Curious about new
technology
• Relate well to feelings and
thoughts of others
• Determined/tenacious
Personal qualities that
describe me:
• Compassionate and caring
• Good at following directions
• Conscientious and careful
• Patient
• Good listener
School subject that I like:
• Art/Graphic Design
• Music
• Speech & Drama
• Journalism/Literature
• Audio/visual technologies
Total number
circled in Box
3
School subject that I like:
• Computer
Applications/Business and
Information Technology
• Accounting
• Math
• English
• Economics
Total number
circled in Box
4
Personal qualities that
describe me:
• Compassionate and caring
• Good at following directions
• Conscientious and careful
• Patient
• Good listener
School subject that I like:
• Biological Sciences
• Chemistry
• Math
• Language Arts
• Occupational Health
Classes
Total number
circled in Box
5
Activities that describe what I like to do:
• Perform routine, organized activities but can be flexible.
• Work with numbers and detailed information.
• Be the leader in a group.
• Make business contact with people.
• Work with computer programs.
• Create reports and communicate ideas.
• Plan my work and follow instructions without close
supervision.
Activities that describe what I like to do:
• Work under pressure.
• Help sick people and animals.
• Make decisions based on logic and information.
• Participate in health and science classes.
• Respond quickly and calmly in emergencies.
• Work as a member of a team.
• Follow guidelines precisely and meet strict standards of
accuracy.
(Turn over to complete back)
BOX 6
BOX 7
BOX 8
BOX 9
BOX 10
Activities that describe what I like to do:
• Investigate new places and activities.
• Work with all ages and types of people.
• Organize activities in which other people enjoy
themselves.
• Have a flexible schedule.
• Help people make up their minds.
• Communicate easily, tactfully, and courteously.
• Learn about other cultures.
Personal qualities that
describe me:
• Tactful
• Self-motivated
• Works well with others
• Outgoing
• Slow to anger
School subject that I like:
• Language Arts/Speech
• Foreign Language
• Social Sciences
• Marketing
• Food Services
Total number
circled in Box
6
Activities that describe what I like to do:
• Care about people, their needs, and their problems.
• Participate in community services and/or volunteering.
• Listen to other people’s viewpoints.
• Help people be at their best.
• Work with people from preschool age to old age.
• Think of new ways to do things.
• Make friends with different kinds of people.
Personal qualities that
describe me:
• Good communicator/listener
• Caring
• Non-materialistic
• Uses intuition and logic
• Non-judgmental
School subject that I like:
• Language Arts/Speech
• Psychology/Sociology
• Family & Consumer
Sciences
• Finance
• Foreign Language
Total number
circled in Box
7
Activities that describe what I like to do:
• Work with computers.
• Reason clearly and logically to solve complex problems.
• Use machines, techniques, and processes.
• Read technical materials and diagrams and solve
technical problems.
• Adapt to change.
• Play video games and figure out how they work.
• Concentrate for long periods without being distracted.
Personal qualities that
describe me:
• Logical/analytical thinker
• Sees detail in the big picture
• Persistent
• Good concentration skills
• Precise and accurate
School subject that I like:
• Math
• Science
• Computer Tech/ Applications
• Communications
• Graphic Design
Total number
circled in Box
8
Activities that describe what I like to do:
• Work with hands and learn best that way.
• Put things together.
• Do routine, organized and accurate work.
• Perform activities that produce tangible results.
• Apply math to work out solutions.
• Use hand and power tools and operate
equipment/machinery.
Personal qualities that
describe me:
• Practical
• Observant
• Physically active
• Step-by-step thinker
• Coordinated
School subject that I like:
• Math-Geometry
• Chemistry
• Trade and Industry courses
• Physics
• Language Arts
Total number
circled in Box
9
Activities that describe what I like to do:
• Travel
• See well and have quick reflexes.
• Solve mechanical problems.
• Design efficient processes.
• Anticipate needs and prepare to meet them.
• Move things one place to another.
Personal qualities that
describe me:
• Realistic
• Mechanical
• Coordinated
• Observant
• Planner
School subject that I like:
• Math
• Economics
• Trade and Industry courses
• Physical Sciences
• Foreign Language
Total number
circled in Box
10
Identify the boxes with the three highest numbers and list them in order on the lines below:
1st Highest
2nd Highest
3rd Highest
Locate the cluster(s) below that relate to your three highest boxes. Circle the ICTC Career Major you are most interested in learning
more about.
Cluster
BOX 1
AGRICULTURE, FOOD
NATURAL RESOURCES
BOX 2
ARCHITECTURE &
CONSTRUCTION
BOX 3
ARTS, A/V TECHNOLOGY &
COMMUNICATIONS
BOX 4
BUSINESS, MANAGEMENT &
ADMINISTRATION
BOX 5
HEALTH SCIENCE
BOX 6
HOSPITALITY & TOURISM
BOX 7
HUMAN SERVICES
BOX 8
INFORMATION TECHNOLOGY
BOX 9
MANUFACTURING
BOX 10
TRANSPORTATION,
DISTRIBUTION & LOGISTICS
Description
&
ICTC Career Major(s)
The production, processing, marketing, distribution, financing, * Service Careers
and development of agricultural commodities and resources
Building & Grounds Maintenance
including food, fiber, wood products, natural resources,
Technician’s Assistant
horticulture, and other plant and animal products/resources.
Careers in designing, planning, managing, building, and *CAD Technician Mechanical
maintaining the built environment.
*Residential/Commercial Carpenter
* Electrician’s Assistant
*Residential HVAC Technician
Designing, producing, exhibiting, performing, writing, and *Graphic Artist and Printing Production
Technician
publishing multimedia content including visual and performing
arts and design, journalism, and entertainment services.
Careers that encompass planning, organizing, directing and *Executive Administrative Assistant
evaluating business function essential to efficient and *Medical Office Assistant
productive business operations.
*Medical Insurance Coder
Occupations that require planning, managing, and providing *Long-Term Care/Home Health Care
therapeutic services, diagnostic services, health informatics, Assistant (HS Only)
support services, and biotechnology research and * Nursing Transitions (2nd Year Studentsdevelopment.
By Approval Only)
*Sports Medicine (HS Only)
*Practical Nursing (Adult Only)
*Radiologic Tech (Adult Only)
*Occupational Therapy Assistant (Adult
Only)
Careers that encompass the management, marketing and *Hospitality Manager
operations of restaurants and other food services, lodging,
attractions, and recreation events and travel-related services.
Preparing individuals for employment in career pathways that *Cosmetologist (HS Only)
relate to family and human needs.
Building linkages in IT occupations framework for entry-level, *Enterprise Network Associate
technical, and professional careers related to the design,
development, support and management of hardware,
software, multimedia, and systems integration services.
Processing of materials into intermediate or final products and *Manufacturing Technician
related professional and technical support activities such as *Structural Welder
production planning and control, maintenance, and *Pipe Welder
manufacturing/process engineering.
Planning, management, and movement of people, materials, *Automotive General Service Technician
and goods by road, pipeline, air, rail, and water and related *Collision Repair Technician
professional and technical support services.
Note: Your interests may change from time-to-time. These survey results are intended to help you with informal career exploration for the career
majors that are offered at our school. It does not make any claims of statistical reliability.
For more information, check with a career counselor at your high school, Career Tech Center, higher education institution, or one-stop career
centers.
Indian Capital Technology Center does not discriminate on the basis of race, color, religion, national origin,
sex/gender, age, disability, marital or veteran status.