Admissions Application

Student Type*

What student type best describes your admission application?

Campus*

What campus would you like to attend?

Program Type*

What program type would you like to enroll?

Certificate

Diploma

Associate's Degrees

Enrollment Term

Legal Name*

First NameMiddle NameLast Name

Suffix

Previous Last Names (maiden, etc.)

Legal Sex*

MaleFemale

Date of Birth*

Date

Citizenship Status*

U.S. Citizen or U.S. NationalU.S. Permanent ResidentU.S. Refugee or AsyleeNot a U.S. Citizen

Banner Number*

Are you Hispanic or Latino?*

YesNo

Race/Ethnicity (Select all that apply)*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone Number*

Please enter a valid phone number.

Mobile Phone Number*

Please enter a valid phone number.

Choose the one that best applies to you. This will assist Admissions in determining your residency status.*

I am under 24 years old and my parents/guardian claimed me on their most recent tax returnI am under 24 years old and no one claimed on me on their most recent tax returnI am 24 or older

Military Status*

I am not active duty or a dependent of an active military memberActive MilitaryVeteranI am the spouse or dependent of an active military member

Branch Affiliation*

Will you be using Veterans Education Benefits?*

YesNo

Did your father graduate from college?*

YesNoUnknown

Did your mother graduate from college*

YesNoUnknown

Have you taken any of the following Standardized Tests: Accuplacer/Companion, SAT, PSAT, ACT,Pre-ACT?*

YesNo

Choose all the tests that you've taken*

Please enter the name of your high school you attended. If you attend a home school, type 'Home School'. If you received a GED/HiSET/Career Plus HSE type 'High School Equivalency'.

High School Name, City and State*

High SchoolCityState

High School Graduate or High School Equivalency Awarded*

YesNo

Graduation Date or Anticipated Graduation Date (Approximate) *

Date

Have you attended any other postsecondary institutions besides West Georgia Technical College?*

YesNo

#1 College Name, City and State

College/UniversityCityState

Program of Study

Did you earn a degree or credential from this college/university?

YesNo

Start Date of Attendance (Approximate)

Date

Last Date of Attendance / Graduation Date (Approximate)

Date

#2 College Name, City and State

College/UniversityCityState

Program of Study

Did you earn a degree or credential from this college/university?

YesNo

Start Date of Attendance (Approximate)

Date

Last Date of Attendance / Graduation Date (Approximate)

Date

#3 College Name, City and State

College/UniversityCityState

Program of Study

Did you earn a degree or credential from this college/university?

YesNo

Start Date of Attendance (Approximate)

Date

Last Date of Attendance / Graduation Date (Approximate)

Date

#4 College Name, City and State

College/UniversityCityState

Program of Study

Did you earn a degree or credential from this college/university?

YesNo

Start Date of Attendance (Approximate)

Date

Last Date of Attendance / Graduation Date (Approximate)

Date

Name*

First NameLast Name

Phone Number*

Please enter a valid phone number.

Email

example@example.com

Relationship*

BY SUBMITTING THIS FORM, YOU AGREE TO ALL OF THE FOLLOWING STATEMENTS:*

In accordance with the Family Educational Rights and Privacy Act of 1974, students have the right to review, inspect, and challenge the accuracy of information kept in a cumulative file by the college unless the student waives the right. The law further ensures that records may not be released except in emergency situations without the written consent of the student., except in cases authorized by law.
I understand that pursuant O.C.G.A. 16-10-20, it is a felony to make a false statement on any document. In addition, making a false statement may result in dismissal from the college.
I certify that by signing this application I have incurred a $25 application fee and that fee is non-refundable.
I understand that The Technical College System of Georgia (TCSG) and its constituent technical colleges is not liable for any emergency medical attention provided nor for charges incurred from such.
I authorize TCSG and its constituent technical colleges to deduct tuition, fees, and miscellaneous charges owed to TCSG and its constituent technical colleges from my Title IV Financial Aid and all HOPE funded programs.
I give TCSG and its constituent technical colleges permission to contact me at the telephone numbers and email addresses I have provided via any means, including text message or voice. TCSG and its constituent technical colleges will not be liable for any data rates that may apply.
All materials submitted for application become the property of TCSG and its constituent technical colleges and will not be returned to the applicant. I understand that I have the right to inspect and review my education records to the extent allowable under the federal Family Educational Rights and Privacy Act (“FERPA”, 20 U.S.C. § 1232g, 34 C.F.R. Part 99).
I understand that my name, quotations, and photographic likeness may be used in all forms of media for advertising, trade, and any other lawful purpose on behalf of TCSG and its constituent technical colleges and that I will not receive now or in the future, any compensation for this usage. I also understand that my name, quotations, and photographic likeness may be posted on TCSG and its constituent technical colleges’ websites and/or its official social media sites, and can be downloaded by any computer user on or off campus. Therefore, I agree to indemnify and hold harmless the State of Georgia, West Georgia Technical College, the Board of TCSG, TCSG, their members individually, and their officers, agents, and employees, from any and all claims of any kind, whether foreseeable or not, arising from such use of my likeness. I understand that, as a student age 18 or older, it is my responsibility to notify the TCSG and its constituent technical colleges, Amy Dollar at Amy.Dollar@westgatech.edu if I refuse to have my name, quotations, or photographic likeness used for the college’s unlimited purposes. In addition, all students under the age of 18 must have parent or guardian permission for his or her name, quotations, or photographic likeness to be used by the college.
I acknowledge and hereby waive my privacy rights, including but not limited to any rights pursuant to the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g, and grant my permission and authorize TCSG and its constituent technical colleges to release to Bank Mobile any and all of my educational records and non-public directory information in its possession, including but not limited to academic and financial records, as deemed appropriate and necessary by TCSG and its constituent technical colleges to facilitate my financial transactions with West Georgia Technical College. I also grant my permission to and authorize West Georgia Technical College to release the above information to TCSG and its constituent technical colleges. The purpose of this release and disclosure is to allow West Georgia Technical College to exchange information about the payment and receipt of student credit balances.

As set forth in its student catalog, West Georgia Technical College complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, creed or religion, national or ethnic origin, sex (including pregnancy, sexual orientation, and gender identity), disability, age, political affiliation or belief, genetic information, veteran or military status, marital status, or citizenship status (except in those special circumstances permitted or mandated by law). The following persons have been designated to handle inquiries regarding the non-discrimination policies: Equity (Title IX) Coordinator, Melinda Hofius, Dean of Students, 770.537.5722, 176 Murphy Campus Blvd., Waco, GA 30182 or at wgtcdiscipline@westgatech.edu. ADA (Section 504) Coordinators: Students: Zelma Jones, Career and Student Support Services Manager, 770.824.5245, 176 Murphy Campus Blvd., Waco, GA 30182, Student504@westgatech.edu; Employees: Teresa Jiles, Human Resources Manager, 770.537.6056, 176 Murphy Campus Blvd., Waco, GA 30182, wgtcHR@westgatech.edu.

By clicking “submit” for this form, I agree and verify that the above information is true and correct.

Admissions Application

Enrollment Information

Program of Study

Personal Information

Contact Information

Other Information

High School Information

College Information

Emergency Contact

Application Certification and Equity Statement