Gadsden Technical College Enrollment Application

Gadsden Technical College

Enrollment Application
201 Martin Luther King, Jr. Blvd.; Quincy, Florida 32351

Telephone Number: 850-875-8324

*Fax: 850-875-7297

www.gadsdentech.org
Mission:

The mission of Gadsden Technical College is to provide industry linked programs and services opportunities that enable students to take advantage of career goals in order to achieve economic self-sufficiency, contribute to the economic prosperity of Gadsden County, and compete in a global market.

Notification of Nondiscrimination

"No person shall on the basis of sex (including transgender, gender nonconforming and Â gender identity), marital status, sexual orientation, race, religion, ethnicity, national origin, age, color, pregnancy, disability, military status or genetic information be denied employment, receipt of services, access to or participation in school activities or programs if qualified to receive such services, or otherwise be discriminated against or placed in a hostile environment in any educational program or activity including those receiving federal financial assistance, except as provided by law." No person shall deny equal access or a fair opportunity to meet to, or discriminate against, any group officially affiliated with the Boy Scouts of America, or any other youth group listed in Title 36 of the United States Code as a patriotic society.
ATTENTION!!

*NOTE* Please contact Gadsden Technical College Registrar's Office at (850) 875-8324 if you receive the following message when applying "Possible Duplicate Student, this student seems to already exist". The message is indicating that you already have an existing record in our database.
Online Registration may only be completed in the following browsers: Chrome, Firefox, Safari

Name*

First NameMiddle NameLast Name
Previously Used Name

First NameMiddle NameLast Name
Sex*
Date of Birth*

MonthDayYear
Date
Current Age*
Please type your current age
Residence County (What County do you live in? Example: Gadsden, Leon, Jefferson. If outside of Florida, list county and state. Example: Decatur county GA)?*
I am a: (Florida Residency) Please select one*

*Florida Resident*Non-Florida Resident*Non-Florida Resident paying differential out-of-state fee*Residency determination not required (Continuing Education student or statutory emption.
Citizenship:*
Country of Birth*
Ethnicity:*
Race:*
Social Security Number*
USE OF SOCIAL SECURITY NUMBERS:

The School District of Gadsden County is authorized to collect, use or release social security numbers (SSN) of students and/or parents for the following purposes, which are noted as either required or authorized by law to be collected. The collection of social security numbers is either specifically authorized by law or imperative for the performance of the District’s duties and responsibilities as prescribed by law [F.S. s, 119.071(5) (a) 2 & 3]. The following are examples of allowable uses of SSN: Student Registration/ID Numbers; Tracking Adult Students in Postsecondary Programs; Criminal History, Level 2 Background Checks; Reports for FLDOE; Free/Reduce Priced Lunch Eligibility; Verification from Employer for Vocational Education, Student Follow-up; Reporting Child Abuse; Complying Federal Law Requirements; and Password Verification in Accessing the District’s Network.

Native Language of Student*
Primary Language Spoken in the Home*
(For Adults Only!) - Is your English Proficiency limited?

NoYes
I am a: (Single parent information)*
Are you a Displaced Homemaker?*
Homeless Individual or Runaway Youth*
Migrant and Seasonal farmworker*
What is your current employment status?*
Barriers to Employment*
Income Status, Adults:*
Are you a Military Veteran?*

Yes (documentation will be required if accepted into the program)No
Military Status*

Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Physical Address (if different from Mailing Address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Primary Phone Number*
Please enter a valid phone number.
Secondary Phone Number
Please enter a valid phone number.
Email*
example@example.com

EMERGENCY CONTACT INFORMATION*

First NameLast Name
Emergency contact relationship to you:
Emergency contact phone Number:*
Please enter a valid phone number.

Have you earned a High School Diploma or GED**
What year did you receive your high school diploma/GED? blanks
Highest educational level: (Select One)*
Origin of Schooling, Adults:*
Name and location of the last school attended:*
You must submit official (sealed/unopened) transcript(s) to Gadsden Technical College. Transcript(s) can be sent electronically through the FASTER system (preferred) from your pervious school. Transcript(s) can also be mailed or hand delivered to: 201 Martin Luther King Jr. Blvd.; Quincy, FL 32351
If you are disabled, will you be providing documentation of disability?

How did you learn about Gadsden Technical College
Have you been enrolled in Gadsden Technical College in the past?*

NoYes
If yes, what program and what year were you enrolled?
Have you completed the current year Federal Financial Aid (FAFSA)* Use the link below to apply for Federal Financial Aid (FAFSA):

YesNo
Federal Financial Aid (FAFSA)

https://studentaid.gov
Are you prepared to meet the financial requirements of this Program?

NoYes
If yes, please explain how.

Have you ever been convicted of a felony?*

No- Not an Ex-OffenderYes- Is an Ex-OffenderZ- Not Enrolled in the National Reporting System (NRS)
If yes, please explain.
Supporting Document Upload

The application process is not complete until all required (*) supporting documents listed below are uploaded.
Official Identification (Example: Current Driver’s License or Current State ID)*

If you can not submitted this required (*) "document at this time", then hit the "Save and Continue Later" button. This will allow you to return at a later date to upload your document.
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First Time Student?
Type of Dual Enrolled High School Student*
If you are a Dual Enrolled High School Student, Do you have a 504 or IEP*
Program of Interest*
Time Preference *
Time Preference (Adult Education)*
Time Preference (Practical Nursing)*
Time Preference (Commercial Class "B" Driving)*
Semester Enrollment Preference "A"*
Semester Enrollment Preference "B"*
Semester Enrollment Preference "C"*

If you are applying for a Health Science Program (Practical Nursing or Pharmacy Technician), there is additional information required. Please indicate if you are applying for a Health Science Program:

Pharmacy TechnicianPractical NursingN/A - I am not applying for a Health Science Program

Supporting Document Upload

The application process is not complete until all required (*) supporting documents listed below are uploaded. Hit the "Save and Continue Later" button at the bottom of this page, which will allow you to return to your application for submission of documents at a later date. All documents must be uploaded prior to the closure of the open enrollment period. Seating for this Pharmacy Technician Program is limited, therefore all applicants are encouraged to complete the application process in an expeditious manner.
A Copy of Your TEAS Test Scores (For Adults Only) / For High school Dual Enrolled students a copy of your Entrance Test results*

Remotely proctored TEAS scores will not be accepted. Only scores from an official testing site/facility will be accepted. All supporting documents must be uploaded to complete the application process.
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Reference Letters: 3 for Adults & 2 for Dual Enrolled High School*

If you can not submitted this required (*) "document at this time", then hit the "Save and Continue Later" button. This will allow you to return at a later date to upload your document.
Cancelof
Immunizations Record*

If you can not submitted this required (*) "document at this time", then hit the "Save and Continue Later" button. This will allow you to return at a later date to upload your document.
Cancelof

Employment/Work Experience:*

	Name of Employer	Job Title/Position	Employment Start Date: (MM/YYYY)	Employment End Date: (MM/YYYY)
Employer #1
Employer #2
Employer #3
Employer #4
Employer #5
Employer #6
Employer #7

Do you have the ability to drive or have reliable transportation to school campus and applicable clinical facilities?*

NoYes
Do you take or use any drugs/medications which may alter logical thinking?*

NoYes
Supporting Document Upload

The application process is not complete until all required (*) supporting documents listed below are uploaded. Hit the "Save and Continue Later" button at the bottom of this page, which will allow you to return to your application for submission of documents at a later date. All documents must be uploaded prior to the closure of the open enrollment period. Seating for this Nursing Program is limited, therefore all applicants are encouraged to complete the application process in an expeditious manner.
A Copy of Your TEAS Test Scores*

Remotely proctored TEAS scores will not be accepted. Only scores from an official testing site/facility will be accepted. All supporting documents must be uploaded to complete the application process.
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Medical History and Physical Examination (Including Immunizations)*

Please visit our website at: (https://content.myconnectsuite.com/api/documents/7d2f1eea86814ed18514a11100a197f2.pdf) to print out the required Medical History and Physical Examination form. All supporting documents must for uploaded to complete the application process.
Cancelof
Three (3) Reference Letters*

If you can not submitted this required (*) "document at this time", then hit the "Save and Continue Later" button. This will allow you to return at a later date to upload your document.
Cancelof
Any Current Medial Certification/Licensure (i.e. CPR, CNA, MA, Phlebotomy, Etc...)

If you can not submitted this required (*) "document at this time", then hit the "Save and Continue Later" button. This will allow you to return at a later date to upload your document.
Cancelof

Review and Submit

Please review your answers and use the back button to make any changes. Once you are satisfied with your responses, then click on the submit button.
Should be Empty:

Mission:

Notification of Nondiscrimination

Online Registration may only be completed in the following browsers: Chrome, Firefox, Safari

Supporting Document Upload

Supporting Document Upload

Supporting Document Upload

Review and Submit