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GATEWAY2TMC DUAL ADMISSION
PROGRAM APPLICATION
Social Security Number _____ _____ _____ - _____ _____ - _____ _____ _____ _____
Gateway ID (Empl ID) _____ _____ _____ _____ _____ _____ _____ _____ _____
Name ______________________________________________________________________
Permanent Address _________________________________________________________
How long has this been your current address? ________________________________
Previous Address _____________________________________________________________
How long has this been your previous address? ________________________________
Phone _____ _____ _____ - _____ _____ _____ - _____ _____ _____ _____
Date of Birth _____ _____ / _____ _____ / _____ _____ _____ _____
Gender (Circle one) Male Female
Citizenship status (circle one)
U.S. Citizen _____
Alien, non-immigrant _____ (Attach copy of I-94 form)
Alien, permanent resident _____ (Attach copy of Resident Alien card)
If not a U.S. citizen, list country of citizenship ___________________________________
OPTIONAL: Ethnic background (check all that apply)
Hispanic or Latino _____
African-American or Black _____
Asian _____
American Indian or Alaskan Native _____
Caucasian or White _____
Native American/Pacific Islander _____
Are you currently serving, or have you served, in the United States military? (Check one)
Yes _____ No _____
Academic Pathway Completing _____________________________ (required, see below)
Anticipated Gateway Graduation (Term/Year) __________________________ (required)
High School ______________________________________ Graduation Year ___________
Date of GED (if appliciable) ____________________
Gateway Email address __________________________________________ @kctcs.edu
Date of Application _______________ Signature ____________________________________
Signature of Gateway Representative ___________________________________________________
Please attach an unofficial copy of your Gateway transcript to this application.
Current Gateway2TMC Academic Pathways
If you want to major in this subject at Thomas
More:
Complete this degree at Gateway:
Accounting
Associate in Applied Science Accounting
Business
Associate in Applied Science -- Business
Computer Information Systems Associate in Applied Science CIT
Criminal Justice Associate in Applied Science Criminal
Justice
Elementary Education Associate in Applied Science Elementary
Ed.
Middle Grades Education Associate in Applied Science Middle
Grades Ed.
RN-to-BSN Nursing Associate in Applied Science Nursing
General Education Associate in Arts/Associate in Science
Please indicate your desired Thomas More major or General Education above
click to sign
signature
click to edit
For more information, please contact the Gateway Transfer Center
Find more information about Transfer Services here.
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