Application Form

Title

First Name*

Last Name*

Email*

Phone*

Address*

Address

City/Town*

State/Province*

Zip

Country

Educational History

High School (or equivalent) Name*

School Address*

Date of Completion*

College (last attended) Name

College Address

Date of Completion

Highest Degree and Major

Graduate

Other Education (Please list all other educational achievements including correspondence courses, vocational training, seminars, workshops, etc. Please Note: All types of formal education must be verified in writing, i.e., Transcripts or Diploma. Attach an additional sheet, if necessary). IMPORTANT: Please send copies of any supporting documentation to info@iiomonline.com.

Referred By

IIOM Study Intent*

If individual IIOM course was selected, which one?

The IIOM one-time, non refundable registration fee of $45.00 must be paid in full at the time of submission of the IIOM Application. Students may elect to pay for individual courses, one at a time, when working towards completion of a certificate program or degree program. Tuition must be paid before receiving coursework. IIOM also offers tuition installment payment plans. TUITION REFUND POLICY: No refunds are given subsequent to 10 days after enrollment. IIOM mailing address is: IIOM P.O.Box 506 Smithfield, VA 23431 Please call our Enrollment Department if you have any questions - (410) 884-9319 After you click the Send button you will be taken to the Paypal Payment page.

As part of the application review process, IIOM may contact the institutions to validate information submitted by the applicant. Please check the box below to consent for this information to be released.

Yes, IIOM may contact the institutions I attended.