Fillable Williamsburg Technical College Application for Admission

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Williamsburg Technical College Application for Admission

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APPLICATION FOR ADMISSION
601 Martin Luther King, Jr Avenue, Kingstree, SC 29556
843-355-4110 or 800-768-2021 www.wiltech.edu
For
office use: Datatel ID number _________________
PERSONAL INFORMATION
PLEASE PRINT
What is your status: New student Former Student—last date of attendance_________
____________________________________ ____________________________ Male Female
Social Security Number Date of Birth (xx/xx/xxxx)
N
ame
______________________ ___________________ ________________ _______
Last First Middle or Maiden Suffix
For
mer/Maiden Name ____________________________________________________________________________________________
Mailing Address _________________________________________________________________
Street Address/PO Box
__
_____________________________________________ ___________ ____________ ___________
City State Zip County
___
___________________________ _____________________________ __________________________
Cellular Phone Home Phone Business Phone
____________________________________________________________________________________________________________________________________________________
Email Address
Are you Hispanic/Latino? Yes No
I
f you checked no, please select one of the following:
Black or African American White American Indian/Alaska Native
Native Hawaiian or Pacific Islander Asian Two or more races
This voluntary information is used to comply with federal reporting and career planning. It has no effect on admission to the College.
EMERGENCY CONTACT INFORMATION
_______________________________ __________ _________________________
Contact Name Relationship Contact Phone Number
RESIDENCY DECLARATION
Y
ou must complete the residency portion of the application. Applicants that fail to complete all residency questions, will be
classified as non-residents, and be billed at the out-of-county tuition rate.
Are you a legal resident of South Carolina? Yes No Date residency began (xx/xx/xxxx)___________________________
I
n which county do you reside? _______________________________ Which state? ___________________________________
Permit or Driver’s license number/State issued ID number ? _______________________________________________ (Copy Required)
I
s a motor vehicle registered in your name?
Yes Which state? _________ No
A
re you registered to vote?
Yes Which state? _________ No
Have you registered for selective service?
Yes No
Please complete both sides of application and sign.
Are you a Citizen of the U.S.? Yes-Complete the residency questions below the box. No—Complete ALL questions.
Are you a legal immigrant (permanent resident alien) of the USA? Yes-attach a copy of your Immigration card No
Country of Citizenship ___________________________ Permanent Residents: Alien Number ____________________________
Are you here on a Visa? Yes-attach a copy of your passport No
EDUCATIONAL PLANS
I will begin (check one):
Fall Semester (Aug-Dec) Spring Semester (Jan-May) Summer term (May-Aug)
I plan to:
Earn an Associate Degree Earn a Diploma Earn a Certificate
Take courses as a visiting student from another college (TRANSIENT)
Enroll as a High School Vocational (CATE) student
Enroll as a Dual Enrollment Advanced Learning (DEAL) student
Enroll as a High School student taking college courses
My program of study will be:__________________________________________________________________
Any student with a documented disability, who seeks reasonable accommodations,
must contact the Student Development Counselor within 30 days of each semester.
EDUCATIONAL HISTORY
The requirement of high school graduation/GED completion varies by the program of study. However,
for financial aid eligibility, proof of high school graduation/GED criteria must be met. See the current
WTC catalog available online at www.wiltech.edu for details.
High School Attended:______________________________________________________________________
High School (or Home School Association) City State
What is your current status?
I have earned a GED Date of completion (xx/xx/xxxx): ___________________________
I have earned a high school diploma Date of graduation (xx/xx/xxxx): ___________________________
I have received a certificate Date of completion (xx/xx/xxxx): ___________________________
I am still enrolled in high school Expected completion (xx/xx/xxxx): _________________________
I have not earned a high school diploma or GED
Pr
ior College(s) Attended:
College/University Name
City, State
Dates Attended
From To
Degree Earned
I hereby certify that all entries on this form are accurate. I understand that any misrepresentation of residency information will
result in the payment of non-resident fees and I agree to abide by all WTC policies and procedures as outlined in the catalog.
I also understand that my image (photo or video) may used by the college for marketing or instructional purposes in the
course of college classes and activities.
Signature of Applicant_____________________________________ Date_______________
Signature of Parent, if Applicant under age of 18________________________________________________
Accreditation Statement
Williamsburg Technical College is accredited by the Commission on Colleges of the Southern Association of Colleges and Schools (1866
Southern Lane, Decatur, GA 30033-4097; telephone 404.679.4500) to award associate degrees.
Statement of Equal Opportunity/Affirmative Action
Williamsburg Technical College provides affirmative action and equal opportunity in education and employment for all qualified persons
regardless of race, color, sex, age, national origin, religion or disability. The College complies with the provisions of Title VI and VII of the
Civil Rights Act of 1964, as amended; Title IX of 1972; Section 504 of the Rehabilitation Act of 1973; and the Age Discrimination Act of 1967.
SA
07/2016
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Williamsburg Technical College Application for Admission

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Completed 4 May 2020

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