* Legal First Name:

Middle Name/Initial:

* Legal Last Name:

* Social Security Number  (this number is converted to an ID number):

* Email Address: (you will receive additional instructions at this address)

* Mailing Address:

* City:

* State:
AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

* Zip Code:

* Primary Phone:

Secondary Phone (cell/business):

* County:

Emergency Contact

* First Name:

* Last Name:

* Address:

* City:

* State:
AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY

* Zip Code:

* Primary Phone:

Secondary Phone (cell/business):

The information in the following section is optional and is not used in determining eligibility for admission (except minimum age). This data is used only in the preparation of statistical reports.

* Gender:
- Male Female

Are you Hispanic/Latino
Yes   No

Please select one or more Race:
American Indian Asian Black or African-American Native Hawaiian or other Pacific Islander White

Citizenship Status

* Are you a US Citizen?
Yes   No

Alien, Non-Resident?
Yes   No

Alien, Resident?
Yes   No

If Yes, Resident Alien Number

and what VISA type

* Are you a Georgia Resident?
Yes   No

* Are you applying for in-state tuition rate?
Yes   No


If 'Yes' enter the following:

Are you a Veteran?
Yes   No

Did your parent(s) or legal guardian claim you on their most recent tax return? 
Yes   No

 If Yes to the above, What is the state of legal residence of the parent(s) or legal guardian who claimed you? 

Has the parent(s) or legal guardian lived in that state for the last 12 consecutive months?
Yes   No

If you are over 24 years of age (or under 24 and neither the parent(s) or legal guardian claimed you on their tax return) have you been a legal resident of Georgia for the last 12 consecutive months?
Yes   No

Education Information

Did you graduate from high school?

Yes
No

Year Graduated:
Year Widthdrew:

Have you received your GED?

Yes
No

Year Received:

Highest Grade Completed:
- 12 11 10 9 8 7 6 5 4 3 2 1 0

College Years Completed:
- 7 or more 6 5 4 3 2 1 0

Degree:

Have you taken any of the following tests?
SAT    ACT    COMPASS

Term you wish to admit:
- Fall Spring Summer

Year:

Classes you plan to attend:
- Day - Part Time Day - Full Time Evening - Part Time Evening - Full Time Online

Do you plan to pursue:
- Associate Diploma Certificate

Program of Study:
Choice 1:
Choice 2:

Institutions Attended

High School

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Diploma/Degree:

College/University (#1)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Diploma/Degree:

College/University (#2)

Name:

Address:

City/State/Zip:

Attended From (date):

To (date):

Diploma/Degree:

Enrollment Information

All official documents must be sent to:
Albany Technical College 
Office of Admissions
1704 S. Slappey Blvd.
Albany, Georgia 31701
(All documents must arrive by the deadline date to ensure early processing).

Pursuant to O. C. G. A. 16-10-20, it is a felony to make a false statement on any state document. In addition, making a false statement on this application may result in your dismissal from the College. By SUBMITTING this application, I agree to abide by the policies and procedures outlined in the ATC Student Handbook and the College Catalog.