6200 College Avenue
Snyder, TX 79549
Fax: 325-574-6524
Instructions: Please print or type. Be sure to answer each question. All documents submitted to the college become part of the official files and
cannot be returned. I acknowledge that academic or disciplinary concerns may be discussed by the appropriate official and my parents or
legal guardian.
U.S. Social Security Number
Maiden Name
Date of Birth
Local Address (Street-Rt-Box) City State Zip Code
Permanent Address (Street-Rt-Box) City State /Country Zip Code
County of Residence
Telephone Number
Work Phone Number
Ethnic Data select all that apply
(These items are used to satisfy State/Federal reporting requirements and in no way affect the admission decision.)
Asian Black/African American Latin/Hispanic White
American Indian/Alaskan Native Hawaiian/Pacific Islander International/Non Resident
Place of Birth:
Country of Citizenship:
1. If either parent has attended college, what is their highest level of education?
1 Year 2 Years 3 Years 4 or more year Completed Bachelor’s or Above Degree
2. Will you be attending Full Time? Yes No
3. Will you be attending on-campus classes at WTC? Yes No
4. Do you need academic help in English, Math, Reading? Yes No
5. Are you an English learner? Yes No
6. Do you receive economic assistance such as Pell Grant Food Stamps AFDC Title A of Social Security Act
JTPA TEC Natl. School Lunch Act Other
7. Are you a single parent with legal custody of minor children and/or a single pregnant woman? Yes No
8. Have you ever been convicted of a felony? Yes No
9. Are you out of the workforce? Yes No
10. Are you homeless? Yes No
11. Are you a foster youth? Yes No
12. Are you a youth with Active Duty Military parent(s)? Yes No
13. Did you graduate from high school? Yes No If YES, give date (month) (year)
14. If you did NOT graduate, did you receive a GED? Yes No Date GED received: (month) (year)
15. Are you currently enrolled in high school? Yes No Anticipated date of graduation: (month) (year)
16. High School last attended:
Name of School City State
17. If you are currently enrolled in high school, will you be attending as a Dual Credit student? (You are enrolling in a class in which you
will earn both high school and college credit. Yes No
(Requires a Dual Credit Enrollment form from your high school. All sections of the form must be completed.)
18. Are you currently taking dual credit classes in your high school through WTC? Yes No
The law requires you to provide your correct
U.S. Social Security Number so WTC can
furnish certain tax return information to the IRS and to you.
19. Have you lived in the county/state for the last 12 consecutive months? Yes No
20. Why are you attending Western Texas College (WTC)? Earn Associates Earn Certificate Transfer Credits
21. What major field of study are you planning to pursue?
22. When do you plan to enter/return to Western Texas College?
Fall, Spring, or Summer Year
23. Is this your first time in college? Yes No If YES, go to the ACKNOWLEDGEMENT section
24. Have you previously attended Western Texas College? Yes No If YES, for Credit? Non-Credit?
If YES: First enrollment at WTC Semester_________Year
Last enrollment at WTC Semester Year
25. What is your current College classification?
Freshman Sophomore (32+ hrs) Over 72 hrs, no degree
Associates Degree Bachelor’s or Above
26. List ALL previously attended colleges or universities below in chronological order. Do not abbreviate. (Please attach a separate
sheet if necessary.)
Failure to disclose this information may result in non-admission or dismissal if enrolled. NOTE: An official transcript that includes grades
from the last semester in attendance is required from ALL institutions previously attended.
Name & Address
Dates of
Type of
Degree earned
I understand that I must furnish an official transcript from my current college and/or high school attended to the Admissions
Office at Western Texas College. High school transcripts* must have a date of graduation included.
*An official high school transcript must include date of graduation (after graduation has occurred), be signed and
stamped/embossed by a school official, and arrive in the Admissions Office in a sealed envelope or Electronically delivered
from the issuing school.
I understand that the information I have submitted will be relied upon by the college officials to determine my status for
admission and residency eligibility. I authorize the college to verify the information I have provided. I agree to notify
officials of any change in the information provided. I certify that the information on this application is complete and correct
and understand that the submission of false information is grounds for rejection, reversal of acceptance, cancellation of
enrollment, or initiation of disciplinary action. I further certify that I have been provided with information regarding
Bacterial Meningitis and will acquaint myself with these facts. This signature gives permission for WTC to retrieve
testing scores, if necessary.
Western Texas College is an equal opportunity institution and is in compliance with the Americans with Disabilities Act.
Applicants are accepted and considered without regard to race, color, creed, sex, national origin, veteran’s status or disability
Revised September 30, 2019
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