Fillable DTC Application- July 9-10 (revised) (Denmark Technical College)

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DTC Application- July 9-10 (revised) (Denmark Technical College)

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P.O. Box 327 •1126 Solomon Blatt Boulevard •Denmark, SC 29042-0327
Telephone 803.793.5149 • Fax 803.793.5942
Visit us @ www.denmarktech.edu
APPLICATION INSTRUCTIONS &
GENERAL INFORMATION


      
       
        
      
  

2.      
       

U
    

        
        
         
       

3.          
   



1. 

2.         
 
  
       

U


   
      


   
       
        
    


        
    

      
  


         

 



  
    
        
       
  

      


 


       

       
  




      










 
 
 

 
 
 
 
****************************************************
Disclaimer:
Denmark Technical College does not discriminate in any respect
against a student, or applicant for admission as a student, based
on race, color, age, religion, national origin, sex, or disability.
Service Area Proviso: Denmark Technical College
was established
in 1947 and has "a legislated mandate to
serve
students throughout the state."
DENMARK TECHNICAL COLLEGE
ADMISSION APPLICATION
Student Enrollment Status
□ New: First-Time Freshman
□ Readmit: Did not attend DTC in previous semester
□ Transfer: Coming to DTC from another college or university
□ Transient: Attending another college, enrolling at DTC for a c ourse
□ Dual Enrollment: High school student taking college courses
Semester to enter DTC
□ Fall (August – December)
□ Spring (January – May)
□ Summer (May – July)
Year:
______
PLEASE PRINT CLEARLY (USE BLUE OR BLACK INK)
Social Security #: ________/_________/__________
Full Name (Last, First, Middle):
Mailing Address:
City: ________________________________________ County: _______________________________
State: ___________ Zip: _____________
Home Telephone: (
) _________________________________________
Cell Phone: ( ) __________________________________
Email Address:
Date of Birth: _______/________/__________
S
ex: □ Male □ Female
Do you require on-campus housing? □ Yes □ No
Do you require Financial Aid? □ Yes □ No
Are you a Veteran? □ Yes □ No
Have you ever been convicted of a felony? □ Yes □ No (If yes, please attach explanation)
*Ethnicity: □ Hispanic or Latino □ Not Hispanic or Latino
Non-Hispanics Only
□ American Indian or Alaska Native
□ Asian
□ Black or African American
□ Natve Hawaiian or other Pacific Islander
□ White
*This information is voluntary and will not be used in the admissions process in a discriminatory manner.
Name of High School Last Attended:
______________________________________
Location (City/State):_________________________
Are you a High School Graduate? □ Yes □ No If yes, graduation date (Month/Year): ______/_______
Did/will you earn a: □ High School Diploma □ High School Certificate □ GED
State where GED was taken: _________________________
Month/Year GED received: _______/________
Have you taken the ACCUPLACER Placement Test? □ Yes □ No (If yes, please have scores sent to the Admissions Office.
)
PERSONAL INFORMATION
EDUCATIONAL EXPERIENCE
Previous College or University
City/State
Dates Attended
Grad
Grad Date
Degree Received
□
□
□
Residency Status Information
Are you a nonresident □ Yes □ No
alien?
Are you a U.S. Citizen? □ Yes □ No
Are you a legal resident □ Yes □ No
of South Carolina?
___________________________
SC County of Residence
COLLEGE USE ONLY
Student ID#: ______________________
Keyed by: ________________________
DEGREE, DIPLOMA, & CERTIFICATE PROGRAMS OF STUDY
Please check the program you wish to enter
COLLEGE TRANSFER
PROGRAMS, DIVISION
OF ARTS & SCIENCES
DIVISION OF BUSINESS,
COMPUTER & RELATED
TECHNOLOGIES
DIVISION OF PUBLIC
SERVICE
DIVISION OF INDUSTRIAL &
RELATED TECHNOLOGIES
ASSOCIATE DEGREES
ASSOCIATE IN APPLIED
SCIENCE, major in:
□ Administrative Office
Technology
□ Computer Technology
□ General Business
CERTIFICATE IN APPLIED
SCIENCE, major in:
□ Accounting
□
Cybersecurity
□
Entrepreneurship/Small
Business
□
Multimedia-Web/Graphics
Design
□ Word Processing
DIPLOMA IN APPLIED SCIENCE,
major in:
□ Administrative Support
□ Barbering
□ Cosmetology
ASSOCIATE IN APPLIED
ASSOCIATE IN APPLIED
□ Associate in Arts
□ Associate in Science
□ Associate in Applied
Science, major in
General Technology
SCIENCE, major in:
□ Criminal Justice
□ Early Care & Education
□ Human Services
CERTIFICATE IN
SCIENCE, major in:
□ Electromechanical Engineering
Technology
CERTIFICATES
□ General Studies
□ Pre-Medical
APPLIED SCIENCE, major in:
□ Criminal Justice
□ Culinary Arts
□ Early Childhood Development
□ Gerontology
CERTIFICATE IN APPLIED SCIENCE,
major in:
□
Building Construction
Fundamentals
□ Computer Servicing & Repair
□ Plumbing
□ Welding
DIVISION OF NURSING
DIPLOMA IN APPLIED
SCIENCE, major in:
□ License Practical Nurse
CERTIFICATE IN APPLIED
SCIENCE, major in:
□ Nurse Aide Assistant
*Subject to Change
EMERGENCY CONTACT INFORMATION (provide at least 1)
Full Name:
_____________________________________________
Full Name:
_____________________________________________
Relationship to you: □ Parent □ Spouse □ Guardian Relationship to you: □ Parent □ Spouse □ Guardian
□ Other ____________________ □ Other ____________________
Telephone: Home (
) __________________________________
Telephone: Home (
) _______________________________
Cell (
) ____________________________________
Cell (
) __________________________________
SIGNATURE
I certify that all information provided is accurate and complete to the best of my knowledge. I realize that any falsification of information or
willful omission of requested information may be sufficient cause for the college to cancel my enrollment.
Applicant’s Signature Date
__
How did you hear about Denmark Technical College? (Check all that apply)
□ Alumni □ College Recruiter □ Internet □ Newspaper □ Radio □ Television □ Other _____________________________________
There shall be no discrimination, in any respect, by Denmark Technical College against a student, or applicant for admission as a student,
based on race, color, age, religion, national origin, sex or disability. For inquiries on nondiscrimination policies, contact:
Sharon Miller, Disability Coordinator, 1126 Solomon Blatt Blvd., Denmark, SC 29042, or call (803) 793.5274.
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DTC Application- July 9-10 (revised) (Denmark Technical College)

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Completed 26 July 2020

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