CDL Online Education Enrollment Form

North Central Kansas Technical College

CDL Online Education - Application and Enrollment Form


The North Central Kansas Technical College does not discriminate on the basis of sex, race, color, religion, national origin, age, handicap or marital status in admission or access to, or treatment of, or employment in its programs and activities. If you have questions regarding the below, please contact the NCKTC Dean of Student Services (1.800.658.4655).


Admission Requirements:
The information furnished to the college will not be used to deny admission, but is needed for reporting purposes.


High School students may enroll as special students if they have earned high school junior status and have written permission from their high school principal or counselor. If you have further questions, please contact the Registrar's Office.



1. Please complete all questions as completely and accurately as possible.
2. Submit this form.
3. Pay a $50 application fee and $112.50 per credit hour. All fees must be paid before enrollment is completed.





* Indicates the question is required to submit the form.


Step 1: Please complete all questions as completely and accurately as possible


*Today's date
*Last name
*First name
*Middle name
Maiden name
*Email address
NOTE: Your E-mail address must be accurate as you will receive confirmation at this address.
*Home Phone
*Cell Phone
*Street address
*Zip/Postal code
*Social Security #
*Date of Birth
Are you a US Citizen?
Are you a Kansas Resident?
Are you active-duty military?
Are you a military dependent?
Are you a Veteran?
Do you have a driver's license?
*Are you a current high school student?
High School Last Attended
City State
Graduate?    Year of Graduation 
If you did NOT graduate from high school, do you have a GED?    Year Obtained
           Associate Degree College State: Year:
            Bachelor Degree College State: Year:
            Masters Degree College State: Year:
         Doctorate Degree College State: Year:
       Current or Last Enrollment State: Year:
                          Ethnic Group
*Is this your first On-line Course?  
Are you a first-time college student?
Have you previously
attended NCKTC
If Yes, dates attended (Yr.)
Are you transferring from another college?
Are you a special student (limited hours)?
Do you plan to earn a degree from NCKTC?
Will you transfer after receiving your degree?
              Father's Education Level
             Mother's Education Level
*Payment Method


You may enroll in CDL courses and training at any time. Courses and Training must be completed within 45 days after course begins. Please consult the CDL Home Page for specific course and enrollment questions.
Course Title Cr Hours Instructor
 CDL100 CDL Class A to include modules: Orientation, Entry Level, Pre Trip and Skills, General Knowledge, Air Brakes, Combination 1 Hr Shamburg
 CDL100 CDL Class B to include modules: Orientation, Entry Level, Pre Trip and Skills, General Knowledge, Air Brakes 1 Hr Shamburg
 CDL 110 CDL Driver Instruction - $525 Driving Fee plus $112.50 credit hour fee. (Student must contact the CDL Department to schedule driving times @ 1-800-658-4655 ext. 043) 1 Hr Shamburg
CDL Optional Endorsements: Please Select all Endorsements that you want to enroll in.
Each Module is $15
. Please DO NOT include modules already offered with your CDL 100 Course
  Entry Level (2 Modules)
General Knowledge (1 Module)
Air Brake (1 Module)
Combination Vehicle (1 Module)
Double and Triple Trailers (1 Module)
Hazardous Materials (1 Module)
Passenger Bus (1 Module)
School Bus (1 Module)
Tankers (1 Module)
Pre Trip and Skills for "A" Certification (1 Module)
Pre Trip and Skills for "B" Certification (1 Module)
Pre Trip and Skills for "B" Bus Certification (1 Module)
Note: All CDL courses must be paid for before course enrollment in completed.
Students are not allowed to use Federal Financial Aid as a payment method.
Please review the information above and make sure that the information is accurate and up-to-date.

Enrollment will NOT be finalized until payment is received!!

Step 2: Submit this application


Step 3: Pay Online Tuition with PayPal

Online Tuition per Credit Hour

Once this information is submitted it will take at least two business days to process. Please contact the Cashier (1.800.658.4655 ext.003) with payment information as your enrollment will be held until full payment is received.  Online Tuition and fees are non-refundable. You will receive an email acknowledging your completion of the form, full payment and your inclusion into the classes you have selected.


If you are not enrolled into the selected classes you will be notified and further information about when and if you will be able to take the classes will be emailed within two business days of your completion of the form.