Early Start Application

Student Information

First Name*

Preferred Name

Middle Name*

Last Name*

Student Personal Email*
(please do not use your high school email address)

Social Security Number (please omit dashes)*

Date of Birth*

Gender*

Female

Male

Undeclared

High School

What year do you graduate high school?

If going to college, what academic year do you plan to start?

If going to college, what semester do you plan to start?

Primary Academic Interest*

Contact Information

Permanent Address*

Country

Street

City

Region

Postal Code

Student Cell Phone*

Would you like to receive text messages, at this number, from Indiana Tech?

Yes

Early Start Information

Have you been enrolled in Early Start classes in the past?

Year

Term

Are you participating in any of the following programs?

Parent Information

Including parent information is REQUIRED for all Early Start Students.

Parent Type

Parent First Name

Parent Last Name

Parent Mobile Number

Parent Email Address

Early Start Application - 2024.10