Application for admission - Georgia Northwestern Technical ...

1 Georgia Northwestern Technical COLLEGE _____ _____ Application for admission GNTC Student ID_____ (To be assigned by GNTC staff) Application fee paid: _____ admission Procedures: 1. Submit admissions Application with non-refundable $25 Application fee. (No fee is required if you have previously applied and paid the Application fee.) 2. Take the placement test or submit acceptable test scores. 3. Submit official high school or GED transcript. 4. Submit official transcripts from all colleges attended. 5. After steps 1-4 are complete, attend a mandatory on-campus orientation session. Section 1: Personal Information (Please Print Clearly) Social Security Number_____/____/_____ Date of Birth:____/____/_____ ___Male ____Female Name: (as it appears on your social security card) Last Name First Name MI Prior Name Mailing Address: Street City State Zip County Phone: (_____)_____ (_____)_____ (_____)_____ Cell Home Work Section 2: Residency Information Are you applying for in state tuition?

2 ____Yes____No If yes, please provide the admissions office with appropriate documentation as listed under Tuition and Fees all applicants are charged out- of-state tuition until appropriate documentation is provided in most cases, a copy of your drivers license will be sufficient) Citizenship Status: ____US Citizen (US) ____Non-Resident Alien (NR) ____Undocumented Alien (UA) ____Other Non-US Citizen (OC) ____Resident Alien (RA) you must attach a copy of the front and back of Alien Registration Card, Form I-551) Application for admission , page 2 If you are under 24 years of age, did your parent(s) or legal guardian claim you on their most recent tax return? ____Yes ____No If you answered yes, what is the state of legal residence of the parent(s) or legal guardian who claimed you? _____ If you are over 24 (or under 24 and neither of your parents or legal guardian claimed you on their tax return), have you lived in Georgia for the last 12 consecutive months?

3 ____Yes ____No Have you been a legal resident of Georgia , Alabama, or Tennessee at least the last 12 consecutive months? ____Yes ____No If no, list state of legal residence_____ Section 3: Statistical Data Ethnic Background: Are you of Hispanic or Latino Origin? ____Yes ____No ____American Indian or Alaskan Native ____Asian ____Black or African American ____Native Hawaiian or Other Pacific Islander ____White Parents Education Level: (check one) Did your father graduate from College? ___Yes ___No ___Unknown Did your mother graduate from College? ___Yes ___No ___Unknown Section 4: Veterans Status Are you currently on active duty, a veteran, a member of the National Guard, or a Reservist in the Armed Forces? ____Yes ____No Are you a dependent /spouse of an active duty member, a veteran, a member of the National Guard, or a Reservist in the U. S. Armed Forces?

4 ____Yes ____No If YES, Please check one of the following: ___Military Active Army (MAA) ___Military Active Navy (MAN) ___Dependent/Spouse Active Army (RAA) ___Dependent /Spouse Active Navy (RAN) ___Military Active Coast Guard (MAC) ___Military National Guard (MG) ___Dependent Active Coast Guard (RAC) ___Dependent/Spouse Active National Guard (RG) ___Military Active Air Force (MAF) ___Military Active Reservist (MR) ___Dependent/Spouse Active Air Force (RAAF) ___Dependent/Spouse Reservist (RR) ___Military Active Marine (MAM) ___Military Veteran (MV) ___Dependent/Spouse Active Marine (RAM) ___Dependent/Spouse Veteran (RV) Section 5: Entrance Data Campus you plan to attend: (please select one campus not all programs are offered at all campuses) ___Catoosa ___Floyd ___Gordon ___Polk ___Walker ___Whitfield Murray ___Online classes only Semester you plan to attend: ___Fall (August) ___Spring (January) ___Summer (May) ----_____ Application for admission , page 3 Program of Study /Major (as listed in the GNTC Catalog): _____4 Digit Code:_____ Program Level: ___Associate Degree ___Diploma ___Certificate ___Special Status (not applying to a GNTC program of study or financial aid) Applicant/Student Type: (Check all appropriate) ___Beginning Student ___Transfer from another Institution ___Former Student Date/Term Last Attended_____ Major:_____ ___Transient Student (must provide GNTC with a transient letter from home college each semester) Email: _____ ___Audit.

5 No grade or credit received (Space available basis must complete audit request form available on the GNTC website ___Senior Citizens Program: 62 or older/ Georgia Residents Only (Space available basis) Are you currently a high school student planning to enroll at GNTC while still in high school? ___Yes ___No If yes, name of your high school:_____ Section 6: Educational History Official transcripts must be sent directly from the original institution to GNTC in a sealed institutional envelope or by eSCRIP-SAFE . GNTC does not accept faxed transcripts. High school transcripts must include graduations date and type of diploma earned. *Name of High School Attended City State Zip Have you graduated from high school? ___Yes, Graduation year_____ ___No, anticipated date of Graduation_____ *GNTC does not accept special education diplomas or certificates of attendance/completion.)

6 All secondary schools must have appropriate accreditation for acceptance. Have you passed the GED? ___Yes, what year?_____ ___No Did you receive your GED in Georgia ___Yes ___No Education Level Completed: (Circle one) 7 8 9 10 11 12 Some College Associate Degree Bachelor s Degree Master s Degree or higher _____ Application for admission , page 4 Previous College(s) Name all college, universities, Technical colleges/institutes you have attended. Please do not list colleges where you took continuing education or GED classes. If you are a former GNTC student and have not attended GNTC in the last five (5) years, you will need to resubmit ALL transcripts. Name of Institution City/State Dates Attended Did you graduate Emergency Contact Name Phone Relationship to applicant If you have a documented disability that might require you to receive assistance or accommodations, please contact Sheila Parker at 706-295-6517 (Floyd, Gordon, Polk County Campuses), Brittany Elrod 706-965-1139 (Catoosa / Walker County Campuses), or Kevan Watkins at 706-272-2958 (Whitfield Murray Campus).

7 Section 7: Signature and Verification Information I certify that the information I have given is correct to the best of my knowledge. I understand that pursuant to 16-10-20, it is a felony to make a false statement on any state document. In addition, making a false statement on this Application may result in my dismissal from the college. Upon acceptance to Georgia Northwestern Technical College, I agree to abide by the rules, regulations, and guidelines as set forth in the Student Handbook. I give Georgia Northwestern Technical College permission to contact me at the telephone numbers I have provided via any means, including text message or voice. Signature of Applicant_____Date_____ Georgia Northwestern Technical College takes photographs and videos of students in various programs and at events for use in official marketing materials. Examples of official marketing materials include, but are not limited to, newspaper advertising and articles, magazine advertising and articles, college publications, website advertising, and the college s website.

8 Students agree to release and hold harmless Georgia Northwestern Technical College from and against any claims, damages, action, liability, and expense in connection with the use of their image. Students who do not wish to have their Application for admission , page 5 image used by the college must file a written request with the Marketing and Public Relations Department and must also notify the photographer or videographer of their wishes to be excluded in the case of any general photographs or video being taken. Please submit official transcripts and admission applications to one of the campuses below: Catoosa County; 120 College Park Drive; Ringgold, GA 30736 Floyd County; One Maurice Culberson Drive; Rome, GA 30161 Gordon County; 1151 Highway 53 Spur SW; Calhoun, GA 30701 Polk County; 466 Brock Road; Rockmart, GA 30153 Walker County; 265 Bicentennial Trail; Rock Spring, GA 30739 Whitfield Murray County; 2310 Maddox Chapel Road; Dalton, GA 30721 Georgia Northwestern Technical College is a Unit of the Technical College System of Georgia .

9 As set forth in GNTC s student catalog, GNTC does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or belief, genetic information, veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). The following individuals have been designated to handle inquiries regarding the nondiscrimination policies: Title VI & IX Coordinator: Sonya Briscoe, Floyd County Campus, 706-295-6932, Section 504 and ADA Coordinator: Sheila Parker, Floyd County Campus, 706-295-6517.