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*indicates required field *First Name: *Last Name: *E-mail: Address: City: State: choose one AL - AlabamaAK - AlaskaAZ - ArizonaAR - ArkansasCA - CaliforniaCO - ColoradoCT - ConnecticutDE - DelawareDC - District of ColumbiaFL - FloridaFC - Foreign CountryGA - GeorgiaGU - Guam, US TerritoryHI - HawaiiID - IdahoIL - IllinoisIN - IndianaIA - IowaKS - KansasKY - KentuckyLA - LouisianaME - MaineMD - MarylandMA - MassachusettsMI - MichiganAA - Military(AA)AE - Military(AE)AP - Military(AP)MN - MinnesotaMS - MississippiMO - MissouriMT - MontanaOO - N/ANE - NebraskaNV - NevadaNH - New HampshireNJ - New JerseyNM - New MexicoNY - New YorkNC - North CarolinaND - North DakotaOH - OhioOK - OklahomaOR - OregonNA - Other CountryOC - Out of the USAPA - PennsylvaniaPR - Puerto RicoRI - Rhode IslandSC - South CarolinaSD - South DakotaTN - TenneseeTX - TexasUT - UtahVT - VermontVI - Virgin IslandsVA - VirginiaWA - WashingtonWV - West VirginiaWI - WisconsinWY - Wyoming Zip: *Country: choose one United StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia HercegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote D'IvoireCroatiaCubaCyprusCzech RepublicCzechoslovakiaDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic Of)IraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic OfKorea, Republic OfKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMexicoMicronesiaMoldova, Republic OfMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNeutral ZoneNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSt. HelenaSt. Pierre and MiquelonSudanSurinameSvalbard and Jan Mayen IslandsSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania, United Republic OfThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUSAUSSRUzbekistanVanuatuVatican City State (Holy See)VenezuelaVietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and Tutuna IslandsWestern SaharaYemen, Republic OfYugoslaviaZaireZambiaZimbabwe *Time Zone: choose time zone Alaska Time - AKSTArizona - MSTAtlantic Time - ASTCentral Time - CSTEastern Time - ESTHawaii - HSTIndiana - ESTMountain Time - MSTPacific Time - PSTUniversal Time - GMT/UTCUniversal Time - GMT/UTC + 1Universal Time - GMT/UTC + 2Universal Time - GMT/UTC + 3Universal Time - GMT/UTC + 4Universal Time - GMT/UTC + 5Universal Time - GMT/UTC + 6Universal Time - GMT/UTC + 7Universal Time - GMT/UTC + 8Universal Time - GMT/UTC + 9 Universal Time - GMT/UTC + 10Universal Time - GMT/UTC + 11Universal Time - GMT/UTC + 12 *Phone: -- Work Phone: -- Level of Education Completed: choose one High School DiplomaGEDBachelor's DegreeSome CollegeMaster's DegreeDoctorateAssociate's Degree *Degree of Interest: choose one Associate (AABA) - Business AdministrationAssociate (AABA) - Criminal Justice AdministrationAssociate (AABA) - Information SystemsAssociate (AABA) - Visual CommunicationBachelor's (BBA) - Accounting and FinanceBachelor's (BBA) - EntrepreneurshipBachelor's (BBA) - Healthcare ManagementBachelor's (BBA) - Human Resource ManagementBachelor's (BBA) - International BusinessBachelor's (BBA) - ManagementBachelor's (BBA) - MarketingBachelor's (BBA) - Operations ManagementBachelor's (BBA) - Project ManagementBachelor's (BFA) - Digital DesignBachelor's (BFA) - Web DesignBachelor's (BIT) - Computer ForensicsBachelor's (BIT) - Computer SystemsBachelor's (BIT) - Internet SecurityBachelor's (BIT) - Network AdministrationBachelor's (BIT) - ProgrammingBachelor's (BSCJ) - Special PopulationsMaster's (M.Ed.) - Adult Education and TrainingMaster's (M.Ed.) - Classroom Integration of TechnologyMaster's (M.Ed.) - Curriculum and InstructionMaster's (M.Ed.) - Educational Assessment and EvaluationMaster's (M.Ed.) - Instructional DesignMaster's (M.Ed.) - Leadership in Educational OrganizationsMaster's (MIT) - Information Assurance and SecurityMaster's (MIT) - IT Project ManagementMBA - AccountingMBA - Healthcare AdministrationMBA - Human Resource ManagementMBA - International BusinessMBA - ManagementMBA - MarketingMBA - Operations ManagementMBA - Project Management *Currently Active in Military? choose one Yes No American InterContinental University is accredited by The Higher Learning Commission and a member of the North Central Association. Additional information is available at 312-263-0456 or www.ncahigherlearningcommission.org.