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APPLICATION FOR ADMISSION

Guilford Technical Community College P.O. Box 309 ♦ Jamestown, NC 27282
If you have questions about this application, call 336-334-4822/336-454-1126
Please read before completing application • To be admitted to a curriculum, you must be a high school graduate or have a high school equivalency (GED) certificate. If you do not want to work

toward a degree, diploma or certificate, you can enroll as a special credit student.

• You must have official transcripts from your high school or GED and each post-secondary institution mailed directly to the Admissions Office. All students, including special credit/non-degree seeking students MUST provide evidence of having met all course prerequisites before being allowed to register for classes. • Students should complete their admissions file prior to enrollment. Failure to do so may impact registration.

Instructions:

Please type or print in ink. Please write legibly. Respond to all questions completely, use your legal name and return the application to the Admissions Office at the address shown above. Incomplete applications will be returned. Have you previously applied to GTCC?  Yes  No Currently enrolled, applying to a limited enrollment program?  Yes

* This information is required if you intend to file for Financial Aid and to provide verification of the 1. ___________ /_________ / ___________ Hope tax credit. *Social Security Number
2. _______________________________________________________________________________________________________________________

Last Name Address

First City

Middle State

Former Zip

3. _______________________________________________________________________________________________________________________ 4. _______________________________________________________________________________________________________________________

County of legal residence

State of legal residence

Country of legal residence

5. ( ) area code

__________________ Home Telephone

(

area code

) _______________________ ext. ________ Business Telephone 7. * Ethnicity: Hispanic or Latino  Yes  No

6. Date of birth: ___________ /_______ /___________ (mmddyy) 8. * Race: Choose one or more:
 White

 Black or African American  American Indian or Alaskan Native

 Native Hawaiian or Other Pacific Islander

 Asian 9. * Gender:  F  M

10. E-Mail Address: ___________________________________________________  Summer

11. Year/Term entering 20________  Fall

 Spring

12. Curriculum for which you are applying or Program of interest: ________________________________________________________ (Please indicate one program only) 13. Nursing Applicants check one option only:  Day RN Program (Fall start)  Evening & Weekend RN Program (Spring start) If you are currently an LPN are you interested in:  Day Bridging or  Evening Bridging  Day LPN (Fall start)

14. Enrolling as a:  Freshman (No previous college course work)  Transfer (Any previous college course work)  Returning GTCC student 15. Long term goal at GTCC (check one only): GR TR EP EN PE GU
 To obtain an  Associate Degree  Diploma or  Certificate  To take courses to transfer to another college without earning a degree at GTCC  To enhance job skills in present field of work  To enhance employment skill for a new field of work  To take courses for personal enrichment or interest  Undecided

Federal regulations require that institutions provide consumer information about the school. The Consumer Disclosure is located at: http://www.gtcc.edu/departments/financialAid/generalInfo/consumerInfo.html

(Over)

Masters or higher College Tech Prep/Tech Prep General Prep Other Track Unknown Track College Prep Vocational Prep 1-10 hrs.) City/State_______________________ Dates_______ /_______ City/State_______________________ Dates_______/________ City/State ______________________ Dates_______/________ I certify that the information on this application is correct and complete. indicate where you resided and for what reason: ________________________________________________________________ 20.Bachelors  GED  17 . last school attended prior to earning GED/AHS:__________________ _________Last Year Attended:__________ (state) 32. proof of residency status must accompany application. I agree to abide by the rules and regulations of the college when I am admitted as a student. _____ private.) If no.Adult HS (through a community college)  10th  14 . please check one of the three following categories:  Special Disabled Veteran  Vietnam Era Veteran  Other Eligible Veteran 17. & state):_____________________________ ______________________________________________________________________________________________________ 21./week 40+ hrs.16.) / To (Yr. High school graduation: What year did you graduate? ____________________ . High school attended: ____________________________City____________________County_________________State__________ 28. Highest grade student completed (check one):  Less Than 10th  13 . Have you resided in North Carolina continuously for the past 12 months?  Yes  No If no.College Vocational Diploma  11th  15 -. High School Track(s): CTP - GP - OT - UN - CP - VP - 26. _____ homeschool or _____ correspondence school? 30.Associates  12th  16 .Bachelors  GED  17 . United States Citizen:  Yes  No (If no. city. I am currently:  GTCC Employee  Military/ Military Dependent  Senior Citizen *65+  Consortium If you are a veteran.College Vocational Diploma  11th  15 . High School Status:       25. . 22. Are you dependent on your parents?  Yes  No (If yes. If GED/AHS graduate.Adult HS (through a community college)  10th  14 -./week 11-20 hrs.Associates  12th  16 . list name and address.Bachelors  GED  17 -./week Retired Unemployed. status:  Resident Alien  Refugee  Asylee  Visa Visa type_________  Other_________________________ Country of Origin_______________________________________________ 18. I understand that providing false or incomplete answers may disqualify me from admission and enrollment at Guilford Technical Community College. or What year will you graduate? _____________________ 29. Highest grade father completed (check one):  Less Than 10th  13 -.College Vocational Diploma  11th  15 . Is/was your high school: _____ public.Associates  12th  16 -. * Employment Status: E1  E2  E3  E4  R  UN  US  23. If GED/AHS graduate where was it earned?_________________________ _____________ Month and Year Earned: ________/______ (state) 31. List all colleges attended: (Please list full college name) College __________________________________________ College __________________________________________ College __________________________________________ From (Yr.Masters or higher Highest grade mother completed (check one):  Less Than 10th  13 . _____________________________________________ Signature ______/______/______ Date 02/10 * This is voluntary information used for Federal reporting and has no bearing on admission to the college./week 21-39 hrs.Masters or higher 27.Adult HS (through a community college)  10th  14 . North Carolina legal resident:  Yes  No 19.not seeking employment Unemployed-seeking employment Currently enrolled in high school High school graduate Certificate of completion GED graduate Adult high school graduate (through a community college) Did not graduate 24. GTCC is an Affirmative Action/Equal Opportunity College.