II
~ Chippewa Valley
~
Technical
College
Start College Now Supplemental Information Form
Please complete the information below and return with your Start College Now Application (PI-8700-A).
Student Information
: __________________________________________________________________________
Last Name First Name Middle Name
Social Security Number
: ________________________________________________________________________
(This information is voluntary and will remain confidential. It is not used as a student identification number.)
U.S. Citizen: Yes No
Legal resident of: City Village Township _______________________ County of Residence: ___________________
Expected graduation date: ______/______ (MM/YYYY) High School: ___________________________________________
Ethnicity:
Are you Hispanic or Latino? Yes No
Select any other group or groups that apply to you:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or other Pacific Islander
White
Start College Now Class Fees:
Identify the class(es) below for which you (not the high school) will be paying:
A complete Start College Now application (PI-8700-A) and Supplemental Information form must be received by CVTC no later than:
• December 1 for the CVTC semester beginning in January
• June 1 for the CVTC semester beginning in August
Student grade, behavior and conduct information will be shared by school officials as needed between the high school and CVTC.
I authorize Chippewa Valley Technical College (CVTC) to release my entire college transcript to my current high school. This authorization is in
effect only for the purpose of awarding credit after completing a CVTC course, which my high school has sponsored. I understand that
all coursework taken at CVTC will be included on my official transcript.
Student Signature Date
Parent Signature
Date
Return to: K-12 Relations Coordinator, Chippewa Valley Technical College, 620 W. Clairemont Ave., Eau Claire, WI 54701
For additional information go to: www.cvtc.edu, High School Staff > Start College Now
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