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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)

16. I am currently: GTCC Employee Military/ Military Dependent Senior Citizen *65+ Consortium If you are a veteran, please check one of the three following categories: Special Disabled Veteran Vietnam Era Veteran Other Eligible Veteran 17. United States Citizen: Yes No (If no, proof of residency status must accompany application.) If no, status: Resident Alien Refugee Asylee Visa Visa type_________ Other_________________________ Country of Origin_______________________________________________ 18. North Carolina legal resident: Yes No 19. Have you resided in North Carolina continuously for the past 12 months? Yes No If no, indicate where you resided and for what reason: ________________________________________________________________ 20. Are you dependent on your parents? Yes No (If yes, list name and address, city, & state):_____________________________ ______________________________________________________________________________________________________ 21. * Employment Status: E1 E2 E3 E4 R UN US 23. High School Status: 25. 22. Highest grade student completed (check one): Less Than 10th 13 - Adult HS (through a community college) 10th 14 - College Vocational Diploma 11th 15 - Associates 12th 16 - Bachelors GED 17 - Masters or higher College Tech Prep/Tech Prep General Prep Other Track Unknown Track College Prep Vocational Prep

1-10 hrs./week 11-20 hrs./week 21-39 hrs./week 40+ hrs./week Retired Unemployed- 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. High School Track(s): CTP - GP - OT - UN - CP - VP - 26.

Highest grade father completed (check one): Less Than 10th 13 -- Adult HS (through a community college) 10th 14 -- College Vocational Diploma 11th 15 -- Associates 12th 16 -- Bachelors GED 17 -- Masters or higher

Highest grade mother completed (check one): Less Than 10th 13 - Adult HS (through a community college) 10th 14 - College Vocational Diploma 11th 15 - Associates 12th 16 - Bachelors GED 17 - Masters or higher

27. High school attended: ____________________________City____________________County_________________State__________ 28. High school graduation: What year did you graduate? ____________________ ; or What year will you graduate? _____________________ 29. Is/was your high school: _____ public, _____ private, _____ homeschool or _____ correspondence school? 30. If GED/AHS graduate where was it earned?_________________________ _____________ Month and Year Earned: ________/______
(state)

31. If GED/AHS graduate, last school attended prior to earning GED/AHS:__________________ _________Last Year Attended:__________
(state)

32. List all colleges attended: (Please list full college name) College __________________________________________ College __________________________________________ College __________________________________________

From (Yr.) / To (Yr.)

City/State_______________________ Dates_______ /_______ City/State_______________________ Dates_______/________ City/State ______________________ Dates_______/________

I certify that the information on this application is correct and complete. I understand that providing false or incomplete answers may disqualify me from admission and enrollment at Guilford Technical Community College. I agree to abide by the rules and regulations of the college when I am admitted as a student. _____________________________________________ Signature ______/______/______ Date
02/10

* This is voluntary information used for Federal reporting and has no bearing on admission to the college. GTCC is an Affirmative Action/Equal Opportunity College.