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Griffin, GA 30223
GRIFFIN TECHNICAL COLLEGE 770-228-7348 www.griffintech.edu
Complete and return with a non-refundable $15.00 application fee. Application fee good for one year.
Application will be returned if each item is not answered. If item is not applicable, mark N/A.
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Social Security # Last Name First Name Middle Initial
Previous Names (if any) Mailing Address (include apartment, box or lot number)
Are you a U.S. citizen? If not,* what is your country of lawful residence or citizenship?
(Griffin Tech is not authorized by INS for student visas/non-resident-alien. *Please present Permanent Residence Card for copying.)
If you are under 24 years of age, did one of your parents claim you on their most recent tax return? Yes No If you answered yes, what is the
state of legal residence of the parent who claimed you? How long have they lived continuously in that state?
If you are over 24, (or under 24 and neither of your parents claimed you on their tax return) what is your state of legal residence?
How long have you lived continuously in that state?
The following information is for statistical purposes only and is not used for determining admission.
Sex: Male Female Birthdate / / Ethnicity: Amer. Indian/Alaskan Native Asian Black Hispanic/Latino White Pacific Islander
Multi-racial If multi-racial, list two races
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Email Address Emergency Contact Person Phone Alternate Phone
Circle quarter you wish to enter: FALL WINTER SPRING SUMMER Year Circle session: DAY EVENING
Applying as: New Returning (date last attended ) Transfer Transient Special Admit
Dual Enrollment (high school only) Joint Enrollment (high school only)
Program Desired Seeking: Diploma Degree Certificate
See list of programs on reverse side of this form.
Specialization (if required):
I certify that the above information is correct and that Signature: Date:
misrepresentation may result in invalidating my application.
How did you hear about us?
FOR OFFICE USE ONLY
Test Date: Cashier:
Transfer Credits:
/ /
TEST Reading Writing Math Algebra
Receipt #
LS Classes: RDG ENG MAT / /