Tennessee Technology Center at Whiteville

A Tennessee Board of Regents Institution

Preliminary Application for Enrollment

The Tennessee Technology Center at Whiteville provides an equal opportunity for all persons without regard to their race, sex, color, religion, age, national origin, or handicap in all matters of admission, educational programs, employment, and student activities.

Fill in all fields of the application below. We will E-mail, or contact you, with information pertaining to your application as soon as Student Services reviews the application form.

Last Name: First Name: MI:

Street Address: P.O. Box

City: State: Zip Code:

Phone Number or Birth date:

Social Security Number:

Your E-mail address:

Education

Highest grade/level completed

Last High School Attended:

Date Left or Graduated

Have you ever attended the Tennessee Technology Center at Whiteville before?

List all schools attended since high school, including vo-tech schools, colleges & universities, etc:

Name and Location of School	Hrs earned/degree awarded	Date's attended

Program Information

Persons desiring to enroll in any Tennessee Technology Center must declare an occupational objective. Please read the statements below and indicate your objective by selecting the name of the training program in which you plan to enroll.

To earn a certificate or diploma in the selected program and obtain gainful employment.

To upgrade skills and technical knowledge in my present job and/or take a refresher course in the selected program. (Supplemental Certificate).

Other:

Schedule Preference:

Date you are available to begin training:

Are you eligible to register for the Federal Draft?

If yes, have you registered?

Are you a U.S. Citizen? If no, are you a permanent resident of the U.S.?

Alien Registration Number:

I understand that withholding information requested in this application or giving false information may make me ineligible for admission to the Tennessee Technology Center at Whiteville. With this in mind, I certify the above information to be correct and complete.