Home » Admissions » Apply Online Apply Online Contact Information * indicates required field First Name* Last Name* Middle Initial Suffix Select if applicable Jr. Sr. II III IV PhD MD Maiden Name Street Address City State Zip Code Email* Phone* Mobile Phone Work Phone Social Security Number* Date of Birth* Select Month January February March April May June July August September October November December Select Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Select Day 20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944 What is your gender?* Select a Gender Male Female What is your Citizenship status?* Select a Status U.S. Citizen Permanent Resident Other Is English your primary language?* Select a Status Yes No What is your Ethnic group?* Select a Group White African American Latino/Hispanic Asian Native Hawaiian or Other Pacific Islander American Indian or Alaska Native Two or more races Would not disclose Are you currently or have you ever served in the U.S. Armed Forced? If yes, what is your current Military Status? Select a Status Active Duty Inactive Reserve Military Dependent National Guard National Guard (active or drilling) Reservist (active or drilling) Inactive Res/Guard (not drilling) Spouse of Active Duty Veteran/Prior Service Not Applicable Educational Goals What is your highest level of education attained?* Select a Level High School College GED Which of our (9) locations is closest to you?* Select a Campus Canton, MA Chicopee, MA Enfield, CT Hamden, CT New London, CT Rocky Hill, CT Stratford, CT Waterbury, CT Worcester, MA What program are you interested in?* Select a Campus First I understand I may be contacted via phone call, email and/or text message which may use automated technology, about information on PCI's programs. I understand that this consent is not a condition of purchase, application or enrollment.