ICC New Account Application Form


In order to establish your account for ICC, we need the following personal
information from you. This information will be treated confidentially. 

  *Home Phone Number:         Will be used as your login id
  (Area code with no - or space)
  
  *Contact 1 Name:            Chinese:  (ncn for no Chinese name)
  (Last, First)
  
  *Contact 2 Name:            Chinese:  (ncn for no Chinese name)
  (Last, First)  

  *Street Address:          
  *City:                    
  *State:                   
  *Zip:                      (Enter zip code first to get the state and city autofill)
  
  *Email address:           
  
  *Phone 1:            
  (Area code with no - or space)
  
  *Phone 2:            
  (Area code with no - or space)
  
  Referral Phone Number:  
  
  Please check the courses you or your kids are going to take this semester (2020 Fall):
* Use the C button to copy the content from the field above
SelectedCourse IDStudent NameChinese NameBirth DateGender
Course 1 (Last, First)(Optional)//(mm/dd/yyyy)
Course 2 (Last, First)(Optional)//(mm/dd/yyyy)
Course 3 (Last, First)(Optional)//(mm/dd/yyyy)
Course 4 (Last, First)(Optional)//(mm/dd/yyyy)
Course 5 (Last, First)(Optional)//(mm/dd/yyyy)
Course 6 (Last, First)(Optional)//(mm/dd/yyyy)
Course 7 (Last, First)(Optional)//(mm/dd/yyyy)
Course 8 (Last, First)(Optional)//(mm/dd/yyyy)
Have you used this system before? Yes No If you have never used this system before, please select your password: Password: (At least 8 characters) Retype Password: (At least 8 characters) Before you submit your application, you might want to print your application form for future reference.