Tennessee Technology Center at Jackson

2468 Technology Center Drive
Jackson, TN  38301
731.424.0691
731.424.0807 (fax)
A Tennessee Board of Regents Institution

Lexington Campus
230 South Broad Street
Lexington, TN 38351
731.967.1795
731.967.0087 (fax)		 Humboldt Instructional Service Center
2600 Viking Drive
Humboldt, TN  38343		 McWherter Instructional Service Center
2046 North Parkway
Jackson, TN  38301

The Tennessee Technology Center at Jackson provides an equal opportunity for all persons without regard to their sex, race, color, religion, age, national origin or handicap in all matters of admission, education programs, employments, and student activities.

Please provide the following contact information:

 

 

First Name:        
Last Name:        
Street Address:    
City:                 
State:               
Zip Code:                                                                                  


Work Phone:   
Home Phone:  
E-mail:          

 

Please choose from the following options.....
you may choose more than one.

Career Training Program in Which you Anticipate Enrolling in Jackson:           

Career Training Program in Which you Anticipate Enrolling in Lexington:       

I am interested in attending the following program in Humboldt or at the McWherter Center:      

I am interested in taking courses online.   

 

** For Health Occupation Programs - do not use this application.  Please call 731.424.0691 for more information ** 

 

Enter your high school graduation date:    -- mm/dd/yy
G.E.D. Receive date:    -- mm/dd/yy

Birthdate:        --  mm/dd/yy

Gender:        Male    Female

Are you eligible to register for the Federal Draft?  No    Yes
If yes, have you registered for the Federal Draft?    No    Yes

Enter the date of anticipated enrollment:        -- mm/dd/yy

I understand that withholding information in this application or giving false information may make me ineligible for admission to, or continuation in, the Tennessee Technology Center. By submitting this form electronically, I certify that all the statements on this application are correct and complete. In addition, if I am admitted to the Tennessee Technology Center, I agree to abide by the rules and regulations of this institution.

Date of Submission:        -- mm/dd/yy