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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

Last Name: *

First Name: *

Middle Initial:

Email: *

Street address, PO Box, etc.: *

City: *

State: *

Zip: *

Phone: * #

Last High School Attended: *

City/State of High School: *

Name When Attended (if different from above):

Date Left : *

Highest Level of Education Completed: *

List All Prior Training (if any):

Date You Are Available To Start: *

Plan To Attend: *

Full-time

Part-time

Dual Enrollment

Training Program Preference: *

Are You Presently Employed?: *

Yes

Name Of Employer:

Will you be applying for financial assistance?: *

Yes

(Note: You must have a high school diploma or GED to qualify for Federal Financial Aid.)

Will you be receiving any financial assistance from: *

Are you registered with the Selective Service? : *

Yes

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.

How did you hear about our institution?: *

Tennessee Technology Center at Crump is accredited by the Commission of the Council on Occupational Education.

A Tennessee Board of Regents Institution

The Tennessee Technology Center at Crump is an AA/EEO employer and does not discriminate on the basis of race, color, national origin, sex, disability, or age in its programs and activities. The following person has been designated to handle inquiries regarding the nondiscrimination policies:

            Assistant Director
            Tennessee Technology Center at Crump
            3070 Highway 64
            Crump, Tennessee 38327
            731-632-3393
            Henrietta.lusk@ttccrump.edu

Additionally, the Tennessee Technology Center at Crump’s Title IX Coordinator, designated to monitor and oversee Title IX complaints, may be contacted at:

            Assistant Director
            Tennessee Technology Center at Crump
            3070 Highway 64
            Crump, Tennessee 38327
            731-632-3393
            Henrietta.lusk@ttccrump.edu

Full Non-Discrimation Policy

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