Pulaski Technical College: two year community college in central Arkansas

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Pulaski Technical College Online Application

Application for Admission (after submitting a printable version will be emailed)
Social Security Number:	- - (The SSN is required data to be used as student identification only)
Semester for which you are applying:	Summer I 2010 Summer II 2010 Fall 2010 Spring 2011
Have you attended PTC previously?:	Yes No
If yes, when?: (Semester/Year)	/

Last Name:
First Name:
Middle Name:
Suffix:
Previous/Maiden Name:
Other Names Used on Academic Records (if any):
Permanent Home Address:
City:
State:
Zip:
County (in Arkansas):
Home Telephone:	( ) -
Alternate Telephone:	( ) -
Email Address:	(A current email address is requested and required to enroll in online course)
Date of Birth:	/ / (MM/DD/YYYY)
Gender:	Male Female

Legal Arkansas Resident:	Yes No
If less than one year, provide length of residence:	(If less than six months, documentation should be submitted to the Dean of Enrollment Services for approval of in-state tution)
Selective Service Information Required:	I am registered with the Selective Service I am a current member of the armed forces on active duty I am female I am under 18 years of age I am 26 years of age or older I am a resident alien
Are you currently a member of the Arkansas National Guard?:	Yes No
Ethnic Origin:	Black/African American American Indian/Alaska Native Asian/Pacific Islander Hispanic/Latino White (Information regarding gender and ethnic origin is requested for statistical and reporting purposes only)
Required Information:(Note: Non-resident alien applicants should contact the Director of Admissions for admission requirements and application deadlines.
Citizenship:	U.S. Citizen Permanent Resident Alien (immigrant) (card required) Non-Permanent Resident
Country of Birth:

High School Attended:

(If currently attending, please list anticipated graduation date)

High School Graduation Date:

/ /
(Month/Day/Year)

If you are not a high school graduate, did you complete:

Home School

Home School Graduation Date:

/ /
(Month/Day/Year)

GED Did Not Complete N/A

Date Completed:

/ /
(Month/Day/Year)

Which State:

Students who have not completed high school or GED should consult with admissions staff to determine eligibility for admission.

Have you ever attended another college or university?	Yes
	No

List in chronological order all colleges or universities you have attended.All college and university official transcripts must be sent to Pulaski Technical College prior to registration or a delay in registration will occur. Note: You do not need to list Pulaski Technical College.

1
	Name of Institution and State Located