Mailing Address City State Zip County

Please Circle one: 1 – U.S. Citizen 2 – Foreign Temp. 3 – Foreign Perm. Are you a Veteran? □Yes □ No

Do you consider yourself to be Hispanic/Latino/Spanish Origin? □Yes □ No

Please select one or more: □White □Black or African American □Asian

□ American Indian □Alaska Native □Native Hawaiian/Other Pacific Islander

Country of Origin:

Birth Date: / / Please circle one: Male or Female

Day Phone: Evening Phone:

Distance to School (Estimate the number of miles you will be driving to school one way):

Email Address:

Have you received a Diploma or GED? DIPLOMA or GED Date Received _

High School Diploma Received from:

Do you have a valid driver’s license? ___________________

Date you will be available to start:

DAY (FULL-TIME) PROGRAMS

	COLLISION REPAIR TECHNOLOGY		INDUSTRIAL ELECTRICITY
	AUTOMOTIVE TECHNOLOGY		INDUSTRIAL MAINTENANCE
	BUSINESS SYSTEMS TECHNOLOGY		MACHINE TOOL TECHNOLOGY
	COMPUTER ELECTRONICS		WELDING

This is not a PRACTICAL NURSING or PHARMACY TECHNICIAN application. Applications for Practical Nursing and Pharmacy Technician are released once a year. For more information contact Student Services at 423-744-2814.

What is your employment objective?

Do you have any prior training in the field chosen?

Received where/length of course Are you employed?

Hours employed Employer name and address

How did you hear about our school?

THIS IS AN EQUAL OPPORTUNITY TRAINING FACILITY

A TENNESSEE BOARD OF REGENTS INSTITUTION

In accordance with the Privacy Act of 1974, applicants for admission and enrolled students are advised that the requested disclosure of their Social Security numbers to the Office of Admissions is voluntary. Students who do not provide the (university, college, technology center) with their Social Security numbers will be assigned special nine-digit numbers. This number or the Social Security number will be used: (a) to identify such student records as applications for admission, registration and course enrollment documents, grade reports, transcript requests, certification requests, and permanent academic records and (b) to determine eligibility, certify school attendance, and report student status. Students are notified, however, that only the Social Security number may be used as an identifier for grants, loans, and other financial aid programs according to federal regulations. The student’s Social Security number will not be disclosed to individuals or agencies outside the Tennessee Technology Center at Athens except in accordance with the institutional policy on student records. TTC-0020 revised 7/09

DO NOT WRITE ON BACK - OFFICE USE ONLY

Date placed on waiting list / / Initial

Tour/Pre-Test scheduled on at

Test Scores: Reading______ Mathematics Computation______ Applied Mathematics______

Start letter mailed on must reply by .

“ Responded and will be starting on .

“ Did not respond by the above reply date. Removed from waiting list.

Comments:

FINANICAL AID comments:

ISIR received – Date/number printed

No ISIR received – Dates checked

WIA

TRA

VOC-REHAB

GI BILL

VA VOC-REHAB

OTHER

BARRIERS:

Transportation:

Child Care:_________________________________________________________________________________

Other:_____________________________________________________________________________________

Mailing Address City State Zip County

Have you received a Diploma or GED? DIPLOMA or GED Date Received _

High School Diploma Received from:

INDUSTRIAL MAINTENANCE

THIS IS AN EQUAL OPPORTUNITY TRAINING FACILITY

DO NOT WRITE ON BACK - OFFICE USE ONLY