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Dual Enrollment Students (North Georgia Technical College)

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Page 1 of 2, Continued on Back
Application For Admission/ Readmission
Dual Enrollment Students
APPLICATION PROCEDURES:
1. Return completed, signed application to the NGTC High School Coordinator (Do not pay the application fee).
Scan: Email as attachment to: a d m i s s i o n s @ n o r t h g a t e c h . e d u , or
Fax: 706.754.7777, attention: Admissions, or
Mail: Admissions, North Georgia Technical College, PO Box 65, Clarkesville, GA 30523
2. Submit an official high school or GED transcript and official transcripts from all colleges previously attended.
3.
Take a placement test or submit valid test scores from a previous test ( ACCUPLACER, SAT, ACT, COMPASS, or ASSET).
Section 1 Personal Information
Name:
Date of Birth:
SS #:
Former name(s) (last name on GED, high school, or college transcripts):
Mailing Address:
City:
Zip:
Home Phone:
Home County:
Email:
Cell Phone:
Emergency Contact Name:
Relationship:
Contact Phone:
Section 2 High School Information
Name of High School Attending:
Current Grade:
9
th
Grade
10
th
Grade
11
th
Grade
12
th
Grade
Projected Graduation Year:
Section 3 College Information
List all previous colleges, universities, or technical colleges ATTENDED – including NGTC. (May attach additional sheet)
List most recent school first – Do NOT include schools attended for continuing education or GED classes.
School
Dates Attended
Type of Degree Received
thru
Section 4 Entrance Information (Select one from each category)
4a
Entrance Term:
4b
Entrance Year:
4c
Student Type:
4d
Preferred Campus:
Fall
(Aug – Dec)
New
(Never attended any college)
Blairsville
Spring
(Jan – May)
20
Returning
(Previously attended NGTC)
Clarkesville
Summer
(May – Aug)
Transfer
(Previously attended another college)
Currahee
Section 5 Statistical Data (Check all that apply)
This information is required for purposes of reporting to Federal Compliance agencies only and will not be
used in determining admission status.
5a
Gender:
Male
Female
5c
Race:
American Indian/Alaskan Native (1)
Asian (2)
Black/African American (3)
5b
Hispanic or Latino:
Yes
No
Native Hawaiian/Other Pacific Islander (4)
White (5)
Section 6 US Residency Information
This information will be used to establish residency for tuition/financial aid eligibility.
6a
Are you a United States Citizen?
Yes
No
*Non-citizen permanent residents must present a resident alien card if applying for in-state or
out-of-state tuition rate consideration.
6b
If not a US Citizen, are you a permanent resident?
Yes*
No
6c
If not a US Citizen OR permanent resident, list VISA type.
Section 7 Georgia Residency Information
7a
Have you been a Georgia resident for the past 12 consecutive months?
Yes
No
7b
If you are 24 years of age or younger, list parent/guardian’s state of legal residence:
Indicate the length of time he/she has lived continuously in that state:
Less than 1 year
1 year or longer
As set forth in the student catalog, North Georgia Technical College 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). For complaints or information, contact Mike
King, VP of Student Affairs (706- 754-7711, Title VI, IX, II), or Kay Morgan, special services contact (706-754-7828, Sec. 504/Title I/ADA) at 1500 HWY 197 N, Clarkesville, GA 30523.
This institution is an equal opportunity provider and employer. If you wish to file a Civil Rights program complaint of discrimination, complete the USDA Program Discrimination Complaint Form, found
online at http://www.ascr.usda.gov/complaint_filing_cust.html, or at any USDA office, or call (866) 632-9992 to request the form. You may also write a letter containing all of the information requested in
the form. Send your completed complaint form or letter to us by mail at U.S. Department of Agriculture, Director, Office of Adjudication, 1400 Independence Avenue, S.W., Washington, D.C. 20250-
9410, by fax (202) 690-7442 or email at program.intake@usda.gov. 9/4/17
Section 8 Data Collection
8a
Did your father graduate from college?
Yes
No
8b
Did your mother graduate from college?
Yes
No
8c
Are you eligible for the Free or Reduced Lunch program at your high school?
Yes
No
8d
Are you currently an active duty member, veteran, member of the National Guard, or Reservist in the U.S. Armed Forces?
Yes
No
If YES, what branch?
Air Force
Army
Coast Guard
Marine Corps
Navy
8e
Are you a dependent/spouse of an active duty member, veteran, member of the National Guard, or Reservist in the U.S. Armed Forces?
Yes
No
If YES, what branch?
Air Force
Army
Coast Guard
Marine Corps
Navy
Section 9 Course Selection – High school counselor indicates courses requested by student
Degree - Level Core Courses
Occupational Courses
Vary by Campus and Term
Clarkesville Campus
Blairsville Campus
Currahee Campus
Art Appreciation
Biology
Chemistry
Economics
English
History
Math
Music Appreciation
Physics
Psychology
Sociology
Air Conditioning Technology
Auto Collision Repair
Automotive Technology
Business Technology
CNC Technology (Machine Tool)
Computer Science
Cosmetology
Criminal Justice
Early Childhood Care and Education
Electrical Systems
EMS Professions (18 years & up)
Engineering
Environmental Technology
Healthcare
Horticulture
Marine Engine Technology
Networking
Photography
Web Application Development
Welding and Joining Technology
Business Technology
Computer Science
Cosmetology
Criminal Justice
Culinary Arts
EMS Professions (18 years & up)
Healthcare
Networking
Business Technology
Criminal Justice
Culinary Arts
Early Childhood Care and Education
EMS Professions (18 years & up)
Healthcare
Industrial Systems Technology
High School Counselor Signature:
Date:
Pursuant to O.C.G.A. 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 your dismissal from the college.
I certify that the foregoing information contained in this application is true and correct. I understand that misrepresentation or omission of information will be
sufficient cause for rejection or dismissal. I intend to abide by the rules and regulations of North Georgia Technical College. All materials submitted for
application become the property of North Georgia Technical College and will not be returned to the applicant.
I hereby give permission to the Technical College System of Georgia and all assignees (including NGTC) to use my name, quotes and photographic likeness
in all forms and media for advertising, trade and any other lawful purposes.
I give North Georgia Technical College permission to contact me at the telephone numbers I have provided via any means, including text message or voice.
I understand that by signing this document, I give North Georgia Technical College permission to release information concerning my academic history and
financial aid to the high school specified on page one.
I understand that by signing this document, I give North Georgia Technical College permission to release any and all information from my college records to the
parent / guardian named below:
Parent / Guardian Name (PRINT)
I am aware that high school graduation is required prior to completion/graduation from any North Georgia Technical College program of study.
Applicant (Student) Signature:
Date:
Parent / Guardian Signature:
Date:
The statements set forth in this application are for informational purposes only and should not be construed as the basis of a contract between a student and this institution.
While provisions of this application will be applied as stated, NGTC reserves the right to change programs and services without prior notice.
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Dual Enrollment Students (North Georgia Technical College)

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Completed 25 July 2020

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