GTC Application Form

General Information / * Denotes Required Information

Last Name: *
First Name: *
Middle Initial: *
Address: *
City: *
State: *
Zip: *
Phone Number: *
Work Number:
Date of Birth *
Day:
Year:
Program:*
Quarter:*
Time:*
Email Address *
Social Security Number *

Educational Record / * Denotes Required Information

Educational Information * I certify that I have a standard high school diploma or GED diploma.

High School: *
City *
State *
Graduation Date: *
Area of Study: *
GED Exam Location:
City:
State
Date Taken
Have you ever received financial aid to attend another school?:*
Name of School:
City
State:
Zip:

Personal Information / * Denotes Required Information

Are you a U.S. Citizen?:*

Alien Registration Number:
Driver's License Number:
State
LicensenPlate Number
Mariial Status:*
Number of Dependents *

Family Information / * Denotes Required Information

Name of Emergency Contact (parent, guardian, spouse or friend)*
Contact's Phone Number: *
Contact's Cell Number:
Contact's Work Number:
Address: *
City: *
State:*

Statement of Information Accuracy ( * signature required)

I hereby certify that the information contained in this application is complete, accurate, and true. I understand that any misrepresentation of facts could be cause for refusal of admission, refusal to apply reported transfer work toward degree requirements, revocation of financial aid or dismissal from the college or university. I have also have agreed to submit this application by electronic means. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.

Check the box below *
By checking this box and typing my name below, I am electronically signing my application.
Type in your name *
Date of Submission *

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