Funeral Service Program Application

* = required field

Some content may be updated based on selection

Student Background:

IMPORTANT: Required fields are indicated with a red asterisks (*). Applicants are urged to fill in all blanks when possible. Reviewers will expect an honest effort to complete the application.

Last Name:

First Name:

M.I.:

Student ID:

Social Security #:

D.O.B:

Ethnicity:

Primary Phone #:

Secondary Phone #:

Veteran:

ex. (###)###-####

Gender:

Address:

City:

State:

Zip:

Email Address:

Are you a citizen of the United States?

Have you ever been convicted of a misdemeanor or felony?

Have you already applied to NTCC?

Education Background:

Highest Level of Education:

High School/GED Program Attended:

Graduation or GED Date:

College(s) attended:

Name of school

Major

Dates (From-To)

Graduation Date

Will you be transferring any credits?

Have you attended another mortuary program?

Select the Program in which you want to apply:

Will you be enrolling Full-Time?

Employment Background:

Current Employer:

Position:

Funeral Services Background:

Have you ever worked in Funeral Service?

Are you currently registered as an apprentice?

Have you completed an apprenticeship?

Do you have dependable transportation to attend your clinical experiences / internships?

Do you have relatives in the Funeral Service industry?

In what state do you intend to seek licensure?

What kind of salary do you expect to receive as a provisional Licensee? Per(i.e. week, month, year?)

What kind of hours do you expect to work?

What kind of job responsibilites do you expect to be assigned?

Why is Funeral Service Your Career Choice?

How did you learn about the Funeral Service Program?

Document Uploads:

College Transcript:
(upload any unofficial
transcript available)

State Driver’s License:

Hepatitis B immunization record is a requirement for Funeral Service Education students. The immunizations must be completed in full or have been started (as a condition) to start the program. Students will be required to show proof of their Hepatitis B immunization record several times during the program. Any incomplete Hepatitis B series may result in dismissal from the program. Students must have series complete prior to beginning MRTS 1286 Internship.

I acknowledge this Hepatitis B immunization requirement.

Hep B Shot Record:
(upload shot record,
if available)

Criminal Background:

I acknowledge that having a criminal background could impact my licensure in the state I intend to practice in.

Please wait for files to finish uploading