KTC_Registration Form

Today's Date *

Date

Name *

First Name Middle Name Last Name Suffix

Maiden/Former Last Name

Social Security Number

Gender *

Date of Birth *

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

Do you have a high school diploma or GED equivalent? *

Yes No

Year diploma/GED 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

Registration Form