JobRouter

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	Instructions: Please enter student information. All fields in red require input. Click on "Send" button when complete.

Student Information

For what school year are you applying?
Current Grade

Student Legal Last Name	As appears on Birth Certificate
Student Legal First Name	As appears on Birth Certificate
Student Legal Middle Name	As appears on Birth Certificate
Address
Apartment Number
City
County of Residence
State
ZIP

Gender
Birth Date (MM/DD/YYYY)
Birth City
Was Student born outside of the US?
What is the Student`s country of birth?
Date Student first enrolled in a US School. (MM/DD/YYYY)
	Definition of US Schools (defined as each of the 50 States, the District of Columbia, the Commonwealth of Puerto Rico, and each of the outlying areas including the United States Virgin Islands, Guam, American Samoa, and the Commonwealth of the Northern Mariana Islands.)
U.S. Citizen
Nationality

Ethnic Background	Please Check All that Apply *one selection is required.
A-Asian
B-Black or African American
P-Native Hawaiian or Other Pacific Islander
I-American Indian or Alaska Native
W-White
Is your child Hispanic/Latino?

Student Phone

Program of Study and School District

First Choice: Please select the Program that you wish to study:

Second Choice: Please select the Program that you wish to study:

Enrollment in program and academic course offerings is dictated by maximum class size limits and any program specific requirements as listed below:

* These programs - Cosmetology, Hospitality Services, and Culinary Arts require full-time attendance at TCTC. All other programs may be half-day if the home high school permits that option.

** These programs are offered with the permission of the work study coordinator or home high school supervisor.

*** These programs have specific admission requirements. Please refer to the program brochures available on the TCTC Website. (Students applying for Biotechnology, Cosmetology, Dental Assisting, Exercise Science and Health Science must have a score of proficient or better on the science end-of-course exam.)

Current School
Current School - Other
Has student ever attended programming at TCTC besides the 10th grade tours and career days, such as We Are IT, Summer Career Exploration Camp, or after-school AFJROTC program?
What programming did student attend?

District of Residence
District of Residence - Other

Parent/Guardian/Custody Information

	Please Check All That Apply: (Check at least one)
Parents Single
Parents Married
Parents Divorced
Shared Parenting
Parents Separated
Court Placement

Primary Contact / Legal Guardian

Primary contact is the person (or persons) responsible for the regular care of the student and to whom the school may send school-related correspondence. The primary contact is also the first point of contact for the school in the unlikely event that the child is injured or becomes ill while at school. In general, the Primary Contact refers to the parent(s) or guardian(s) of the student.

Last Name

First Name

Relationship to Student

Same as Student Address

Address

Address2

City

State

ZIP

Phone Number(s)

	Phone Type	Phone Number
	-	-

To add row click on +
to delete select checkbox for row and click on -

E-mail Address

Type of Contact

Please Check All that Apply

Legal Guardian

Please ONLY choose this if this contact is Parent or Legal Guardian

Medical Auth Contact

Available at Work

Living with Student

If your parents are divorced/separated,
are there any court documents limiting contact with you?

If YES, a copy of these documents must be provided to the TCTC Guidance Office in the fall.

Additional Contact (1)

Additional person whom we may contact in an emergency situation

Last Name

First Name

Relationship to Student

Same as Student Address

Address

Address2

City

State

ZIP

Phone Number(s)

	Phone Type	Phone Number
	-	-

To add row click on +
to delete select checkbox for row and click on -

E-mail Address

Type of Contact

Please Check All that Apply

Legal Guardian

Please ONLY choose this if this contact is Parent or Legal Guardian

Medical Auth Contact

Available at Work

Living with Student

Willing to Volunteer

Permission to be copied on correspondence

Signature

I understand the program(s) of study for which my student has applied. I give permission for the student`s home school to send my student`s grades, transcripts and attendance information to the TCTC Guidance Office to be used in evaluating this application.
I also authorize TCTC to access scores on state end-of-course exams.
I understand that when I accept the offer of admission, my student and I agree to abide by the TCTC admission policies and procedures and I also agree to spend the first two weeks of school in the fall of the upcoming school year at TCTC.

Confirm

I understand that I need to read the documents on next page.

<< Please check here

I hereby certify that the statements and information in this application form are true and correct to the best of my knowledge

Please enter your full name