Dual Credit/Early Admission Application
6200 College Avenue
Snyder, TX 79549
Instructions: Please complete this form in blue or black ink. Be sure to answer each question. All documents submitted to the
college become part of your official file and cannot be returned. I acknowledge that academic or disciplinary concerns may
be discussed by the appropriate official and my parents or legal guardian.
Social Security Number: _________ - ________ - _________
Name: _____________________________________________________ Date of Birth: _____ / _____ / _____ Gender: _____
(Please Print: First, Middle, Last)
Mailing Address: ________________________________________ City: _________________ State: _____ Zip: ___________
County: ______________________ Home Phone: __________________________ Cell Phone: _________________________
High School: _________________________________________ Grade Level: ________ Entry Term: ____________________
Ethnic Data (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
1. If either parent has attended college, what is their highest level of education?
___1 Year ___2 Years ___3 Years ___Completed Bachelor's or Above Degree
2. Please check all that apply: (This is used to satisfy State/Federal reporting requirements).
□ Academic Disadvantage □ Economic Disadvantage □ Disable □ Primary Language is English
□ Single Parent and/or Single Pregnant Woman □ Homeless □ in Foster Care □ Active Military Parent(s)
3. Anticipated high school graduation date: ____________ (month) _____________ (year)
4. Have you taken college classes from a previous institution? Yes No If yes, please list previous college or university.
5. What major field of study are you planning to pursue? ____________________________________________________________
Degree: Associate of Arts Associate of Applied Science Certificate Undecided
Parent/Student consent for the release of information and participation in the Dual Credit program for the duration of the
student’s high school career.
I, ________________________________________ and ___________________________________, understand;
(Print: Parent/Legal Guardian Name) (Print: Student Name)
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.