Enrollment Application

Demographics

First Name:*

Middle Name:*

Last Name:*

Gender:*

Female

Male

Student Birthdate:*

Graduation Year:*

Anticipated Start Term*

Anticipated Start Date:

Your High School:*

If Other High School:

Students Email:*

Student Phone #:*

Area Code

-

Phone Number

2

Parent 1 Name:*

Parent 1 Phone #:*

Area Code

-

Phone Number

Parent 1 Email:*

Parent 2 Name:

Parent 2 Phone #:

Area Code

-

Phone Number

Parent 2 Email:

Your Address:*

Street Address City State / Province / Region Postal / Zip Code

3

Students Counselor:*

Transporting to KTEC via:*

Courses

Course Preference:*

Second Choice:

If Dual credit is offered are you interested in taking it?*

Yes

No

2

Session Preference:*

8:00 - 10:30 AM

11:30 - 2:00 PM

Second Choice Time:

8:00 - 10:30 AM

11:30 - 2:00 PM

2

In case 1st choice is full pick a 2nd choice.

2nd Year KTEC student?:*

No

Yes

Note: Additional registration steps for Private, Online, and Home School students. Submit application and contact KTEC for more information.

Additional Note: All satelite (off campus) programs are self transport.

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