Social Security Number Date of Birth

Last Name First Name MI Former Name(s)Mailing Address

City State Zip County

Home Phone Cell Phone Other Phone

Primary Email Alternate Email

Month Day Year

Did you graduate from high school? If yes, what year? If no, when do you plan to graduate?

Did you earn a GED diploma?® ®

If no high school or GED diploma, what is your highest grade completed?

Name of High School City

State

OFFICE USE ONLY

Student ID#

Application Received:

Beginning/1st Time

Returning

Transfer MOWR

Transient Special Admit

Associate Degree Diploma Certificate

Summ

Year

er - May/June

Fall - August

Spring - January

Flint River CampusWhen do you plan to attend? Select one:

List all colleges, universities and technical colleges you have attended or are currently attending:

Which campus do you plan to attend?

Griffin Campus Butts County Center

Henry County Center Jasper County Center

Online Only

_______ / _______ / _______ Receipt # ___________

Complete and return with a non-refundable $25.00 may be exempt.

1.

2.

3.

4.

5.

6.

Major/Program of Study:

application fee. Former students

You MUST submit ALL official transcripts to the SCTC Admissions Office. (Transcripts must be sumbitted in a sealed envelope or via E-Scrip.)

Continued on reverseRevised 09/27/2016

The following information may be used to establish residency for tuition and financial aid eligibility. Failure to provide accurate valid information may impact tuition cost and result in repayment of any financial aid funds received.

Yes No

Yes No

Yes No

Yes No

Yes No

Yes No

Are you 24 years old or younger? If yes, your parents’ state of legal residency?

Are you a Georgia resident?

Have you ever been convicted of a felony? (may affect licensure and/or employment options)

Yes No

Yes No

If yes, how long have you lived in Georgia?

Are you Hispanic/Latino? Yes No Please check all that apply: American Indian/Alaskan Native

Asian White Native Hawaiian/Pacific Islander

Black/African American

Gender: Male Female

Are you applying for in-state tuition? If yes, please provide one of the following:

Did either of your parents graduate from college? Y e s No Unknown

Are you a dependent/spouse of an active duty member, veteran, member of the National Guard, or a Reservist in the U.S. Armed Forces?

Are you currently active duty military, a veteran, a member of the National Guard, or a Reservist in the U.S. Armed Forces?

If you answered yes, please select the appropriate classification:Military Active ArmyMilitary Active Coast GuardMilitary Active Air ForceMilitary Active Marine

Dependent/Spouse Active ArmyDependent/Spouse Active Coast GuardDependent/Spouse Active Air ForceDependent/Spouse Active Marine

Dependent/ Spouse Active NavyDependent/Spouse National GuardDependent/Spouse ReservistDependent/Spouse Veteran

Military Active NavyMilitary National GuardMilitary ReservistMilitary Veteran

Would you like these college transcripts to be evaluated?

Select one of the following:

U.S. Citizen Resident Alien (Must submit copy of the front and back of Permanent Resident Card, Form I-151 or Form I-551) Non-Resident Alien (I am NOT a U.S. Citizen or a permanent resident alien. Foreign tuition rate will apply.)

Yes No

APPLICATION FOR ADMISSION/RE-ADMISSION

GENE

RAL I

NFOR

MAT

ION

PROG

RAM

INFO

PREV

IOUS

EDU

CATI

ONCI

TIZE

NSHI

PST

ATIS

TICA

L DAT

A

RESI

DENC

Y

GA Driver’s License, GA-500, property lease or deed, or GA Voter Registration. Please contact the SCTC Admissions Office if one of these documents is not available.

ENTRANCE REQUIREMENTS

Submit applications and paperwork to: Southern Crescent Technical College Southern Crescent Technical College Flint River Campus Griffin Campus Office of Admissions Office of Admissions 1533 Highway 19 South 501 Varsity Road Thomaston, GA 30286 Griffin, GA 30223 706-646-6148 770-228-7348 877-897-0006 877-897-0006

NOTE: Please contact the Admissions Office if you have a disability or handicap that may require special assistance.

FINANCIAL AIDFinancial assistance is available to qualified students from a variety of federal and state sources. Students at Southern Crescent Technical College can look to several areas for financial aid: Pell Grant, HOPE Grant, and HOPE Scholarship. To be eligible for financial aid, a student must apply for admission, be accepted into an approved program of study, and have a high school diploma or equivalent (GED). Students should apply for financial aid at least two to three weeks before registering for classes. All students must complete the Free Application for Federal Student Aid at www.fafsa.ed.gov. Individuals may apply for financial aid BEFORE being

PHOTOGRAPHIC LIKENESS AND QUOTATION RELEASE POLICY

By signing and submitting this application and upon my admission to Southern Crescent Technical College, I understand that my n ame, quotations, and photographic likeness - including video footage - may be used in all forms of media for advertising, trade, and any other lawfu l purposes on behalf of Southern Crescent Technical College or the Technical College System of Georgia 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 gathered from and posted to SCTC's social media sites and web site and can be downloaded by any computer user on or off campus.

I also understand that, as a student age 18 or older, it is my responsibility to notify the Southern Crescent Office of Student Affairs if I refuse to have my name, quotations, or photographic likeness used for the College's unlimited lawful purposes. In addition, all students under the age of 18 must have parental or guardian permission for his/her name, quotations, or photographic likeness to be used by the College. In this instance, this f orm may be obtained in the Office of Marketing and Public Relations.

STATEMENT OF EQUAL OPPORTUNITY

Southern Crescent Technical College is a Unit of the Technical College System of Georgia.

My signature on this application is my acknowledgment of and agreement with the statements that follow:•I certify that the information contained in this application is true and correct and understand that misrepresentation or omission of information may be cause for rejection or dismissal.•I certify that by signing this application I have incurred a $25* application fee and that fee is nonrefundable. (*Fees subject to change without notice.)•All materials submitted for application become the property of Southern Crescent Technical College and will not be returned to the applicant.•I give permission for SCTC to release information to potential employers as part of the job placement service provided by the college.•I understand that SCTC is not liable for any emergency medical attention provided nor for charges incurred from such.•I give SCTC permission to contact me at the telephone numbers I have provided via any means, including text message or voice. (Standard text messaging rates will apply.)

Signature Date

Emergency Contact Phone

Pursuant to O.C.G.A. 16-10-20, it is a felony to make a false statement on any state document. In addition, making a false statement on this application may result in your dismissal from the college.

Relationship

1. EDUCATION - A high school diploma from an approved agency or a GED is required for entrance to most programs. Home school students requesting admission who did not attend a recognized accredited program must submit a Certificate of Attendance form from the local superintendent’s office or a Declaration of Intent from the Georgia Department of Education along with annual progress reports or a final transcript from junior and senior years including the graduation date.

As set forth in full in the Student Handbook/Course Catalog, Southern Crescent Technical College is an Equal Opportunity Institution and does not discriminate on the basis of race, color, national origin, sex, age or disability.

2. Eligible Applicants: Individuals 16 years of age or older or dually enrolled high school students in the 9th, 10th, 11th or 12th grades who seek access to quality instruction at the post-secondary level are eligible for admissions.

before accepted to the College.

SCTC Application updated frontSCTC Application updated back