KTC_Registration Form

Registration Form

Fill out the form carefully for registration
Date of Registration *

Month Day Year
Date
Name *

First Name Middle Name Last Name Suffix
Maiden/Former Last Name
Social Security Number
Gender *
Date of Birth *

Month Day Year
Mailing Address *

Street Address / P.O Box

Street Address Line 2

City State / Province

Postal / Zip Code
E-mail
example@example.com
Phone Number *
Are you a U.S. citizen? *

Yes No
Previous Education History
Do you have, or are you completing a high school diploma? *

Yes No
Year diploma obtained or expected:
CITY / STATE of school:
If you do not have diploma, do you have a GED?

Yes No
Year GED obtained:
Postsecondary Education: Have you ever attended college or another technical school? *

Yes No
Have you previously attended Knox Technical Center *

Yes No
An official transcript must be given to KTC from any high school you have attended. Please contact your high school to ask what their transcript request requirement is. Should you need a transcript request, you will find one on our website.

High School Equivalency (GED) - to obtain your transcript please go to www.diplomasender.com
Program Interest

Any questions, please call 740.393.2933
TRAINING PROGRAMS

Requires a high school or High School Equivalency diploma

(except for STNA-must be 16yrs +)

^ = Federal Financial Aid is available
PROGRAM INTERESTED IN: (Please check one)

Automotive Technician ^ Certified Administrative Assistant Cosmetology ^ HVACR ^ Health Information Technician ^ IT-Computer Systems/Networking ^ Maintenance Technician ^ Massage Therapy ^ Medical Assistant ^ Nail Technician Phlebotomy Practical Nursing ^ LPN to RN Transition ^ STNA (no high school diploma or equivalency required) Welding Certification ^ Public Safety - EMT Basic Public Safety - EMT Advanced Public Safety - EMS Instructor - 8hr on line module Public Safety - EMS Instructor - 60hr class Public Safety - Firefighter I Public Safety - Firefighter II Public Safety - Fire Officer I Public Safety - Fire Officer II Public Safety - Fire Instructor - 8hr on line module Public Safety - Fire Instructor - 60hr class Public Safety - Live Fire Instructor Public Safety - Emergency Medical Responder
Will you be applying for Federal Financial Aid (Title IV) funding? NOTE: only programs with a " ^ " next to them are eligible for Federal financial aid.

Yes No Undecided
ADULT DIPLOMA PROGRAMS (ADP)

Open to adults 22 and over who currently do not have a high school or High School Equivalency (GED) diploma and want to earn a diploma. A registration fee is not required.
ADP Programs:

ADP-Automotive Technician (Brakes module 96 hrs) ADP-Certified Administrative Assistant (225 hrs) ADP-HVACR (96 hrs) ADP-Nail Technician (200 hrs) ADP-Phlebotomy (174 hrs) ADP-STNA (76 hrs) ADP-Welding (189 hrs)
How did you hear about Knox Technical Center

Employer Family From a former student Google Search Jobs and Family Services KCCC Graduate KTC Graduate Local High School Mailing Newspaper Radio School Catalog School Website Social Media Referred by a Friend Veterans Association Workforce Development Office Other
Knox Technical Center hereby gives notice that it does not discriminate on the basis of race, color, national origin, religion, sex, and disability in the educational programs and activities operated by the district. No student shall be denied admission to the Knox Technical Center or to a particular course or instructional program or otherwise discriminated against for reasons of race, color, national origin, sex, and disability, or any other basis of unlawful discrimination.
Knox Technical Center reserves the right to extend the start date or cancel a program due to insufficient enrollment two weeks prior to the start of the program.
I understand that completion of this registration and payment of the registration fee is not a guarantee of program acceptance. *

YES NO
I agree that upon submission of this registration form, I will comply with the Knox Technical Center/Knox County Career Center policies. *

YES NO
By clicking submit below I agree that all information on this Registration is true to the best of my knowledge *

Yes
Please verify that you are human *
NEXT STEPS:
- Please call or stop in to pay the non-refundable registration fee. (Cash/Check/Charge accepted). 308 Martinsburg Rd., Mount Vernon OH 43050. Phone: 740.393.2933
  - Training Programs...$50
  - Nursing Programs:
    
    STNA...$100
    
    Practical Nursing...$75
    
    LPN to RN...$136
  - ADP Program...$0
- Upon receipt of the registration form/registration fee, you will be registered for the WorkKeys assessment test. To learn more about WorkKeys, please visit the KTC website under Register now tab.
- Your name will be forwarded to the Program Coordinator who will follow up with you to schedule a one-on-one interview. They will help you continue with the additional requirements needed by the individual program.
- Set up a Financial Aid appointment if applicable.
Should be Empty:

Registration Form

Previous Education History

Program Interest