Admissions Application - Move on When Ready
 800 U.S. Highway 29 North  Athens, GA 30601-1500  706-425-3060
Spring (January)
Year and term you plan to enter college: Year
Summer (May)
Fall (August)
Personal Data – Please print clearly and answer ALL Items
Social Security Number
Last Name
First Name
Middle Name
Mailing Address (Include apartment, box, or lot number)
E-Mail Address
City
Zip
State
Home Telephone Number
Emergency Contact – First & Last Name
Gender Male Female
Date of Birth
Are you a U.S. Citizen? Yes
No



County
Emergency Contact Phone
Ethnic/Racial Group American Indian/Alaskan Native
Asian Black Hispanic White Other
If no, nation of citizenship
Yes
 No Have you been in the state of GEORGIA for at least 12 months?
I am UNDER 24 years of age, my parent(s) or legal guardian(s) have claimed me on their most recent federal/state tax
return, and they HAVE resided in the state of GEORGIA for at least 12 consecutive months.
I am UNDER 24 years of age, my parent(s) or legal guardian(s) have claimed me on their most recent federal/state tax
return, and they HAVE NOT resided in the state of Georgia for the last 12 consecutive months.
Name of High School Attending:
Current Grade:  9th
10th
Business, Education & Humanities
 Accounting
 Applied Technical Management
 Business Technology
 Business Management
 Consumer Economics
 Cosmetology
 Culinary Arts
 Early Childhood Care & Education
 Early College Essentials
 Hotel, Restaurant, & Tourism Management
 Marketing Management
 Paralegal Studies Degree
 Social Work Assistant
 Technical Specialist
11th
12th
Expected Graduation Date
Desired Program of Study:
Life Sciences & Public Safety
 Agricultural Science
 Biotechnology
 Criminal Justice Technology
 Emergency Medical Technician
 Fire Science Technology
 Healthcare Assistant:
Dental Assisting
Medical Assistant
Paramedicine
Practical Nursing (LPN)
Surgical Technology
Veterinary Tech Assistant
 Healthcare Science:
Dental Hygiene
Nursing (ADN)
Paramedicine
Physical Therapist Assistant
Radiography
Surgical Technology
Veterinary Technology
Phlebotomy Technician
Technology, Engineering & Mathematics
 Air Conditioning
 Automotive Collision Repair
 Automotive Technology
 Commercial Truck Driving
 Computer Support Specialist
 Diesel Equipment Technology
 Drafting Technology
 Electrical Systems Technology
 Emerging Technologies
 Engineering Science Technology
 Industrial Systems Technology
 Interior Design
 Machine Tool Technology
 Manufacturing Operations Specialist
 Networking Specialist
 Welding and Joining Technology
General Education Courses:  American Government Art AppreciationEconomics English History: US & World Math Psychology Sciences Sociology Speech
Placement Test Taken
SAT
ACT
ACCUPLACER
ASSET
COMPASS
Have NOT taken any of these tests
I certify that the foregoing information contained in this application is true and correct. I understand that misrepresentation or
omission of information will be sufficient cause for rejection or dismissal.
Signature
Date
As set forth in its student catalog, Athens Technical College does not discriminate on the basis of race, color, creed, national or ethnic origin, gender, religion, disability, age, political affiliation or belief, genetic information,
veteran status, or citizenship status (except in those special circumstances permitted or mandated by law). The following individuals have been designated to coordinate the college's implementation of nondiscrimination
policies: Keli Fewox, Director of Student Support, Section 504 and the Americans with Disabilities Act (ADA) Coordinator, Office K-614A, 706/355- 5081, [email protected], Becky Burton, Human Resources , Title VI, Title
VII, Title IX Coordinator (Employees), Office K-514, [email protected], 706/583-2818, and Dr. Leslie Crickenberger, Vice President of Student Affairs, Title IX Coordinator(Students) Office H-774, 706/355-5029,
[email protected], 800 U.S. Highway 29 North, Athens, GA 30601.