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APPLICATION FOR ENROLLMENT TENNESSEE TECHNOLOGY CENTER at Crump 3070 Hwy. 64 W., P.O. Box 89 - Crump, TN 38327 731/632-3393 - Fax 731/631-3018
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Last Name: ..First Name: ..Mid Initial:
Email Address:
Street:
City: .....State: ...Zip:
Phone No:
Last High School Attended:
City/State of High School:
Name when attend (if different):
Date Left: .......Highest Grade Completed: High School Diploma GED 12th Grade 11th Grade 10th Grade 9th Grade 8th Grade 7th Grade Other
List All Prior Training (if any):
Date you are available to start: ......
Plan to Attend: Full-Time Part-Time Dual Enrollment High School Students Only
Training Program Preference: Click the arrow to see programs ---> Auto Body Technology Business Systems Technology Computer Graphics Design Computer InformationTechnology Drafting and CAD Technology Electronic Technology Heating, Ventilation, Air Conditioning, and Refrigeration Industrial Electricity Industrial Maintenance Machine Tool Technology Online Courses Practical Nursing Truck Driver Training Welding
Are you presently Employed Yes No .......
Name of Employer:
Will you be applying for Financial Assistance ....... Yes..... .No
(Note: You must have a high school diploma or GED to qualify for Federal Financial Aid.)
Will you be receiving any financial assistance from Click arrow for options----> WIA TRA Voc-Rehab VA Scholarship Other None
Pursuant to federal law, T.C.A. Section 49-7114, every male who is between the ages of eighteen (18) and twenty-six (26), and is a citizen of the United States must register with Selective Service.
Are you registered with the Selective Service? .... Yes.... No
You can register on-line at www.sss.gov/regist.htm
How did you hear about our institution? ....... Click arrow for options----> Current Student Former Student Friends Relatives TV Radio Newspapers Web-Page Signs Other
Thank you for completing this application. Please make sure all information is correct. It is important that we are able to get in contact with you by day-time telephone. If you do not have a phone, please give a number so that we may leave a message for you.
If you have any questions, or would like to tour the Center, please feel free to contact Student Services at (731) 632-3393 Monday-Friday from 7:30-6:00. We look forward to having you as a student soon!
{This application will be submitted by email to the appropriate office once you click the Submit Application Button}
The Tennessee Technology Center provides an equal opportunity for all persons without regard to their race, sex, color, religion, age, national origin, or handicap. The TTC System is a part of the Tennessee Board of Regents.