Application for Admission - 20/21 1 Contact Information2 Demographic Information3 Citizenship and Residency Information4 Location and Program Information5 High School/High School Equivalency (HSE) and Placement Information6 All Previous College7 Declaration and Signature8 Form Preview9 Confirmation Contact InformationName* First Middle Last List any maiden name or any former last name(s) you have used:Social Security Number*Birth Date* Date Format: MM slash DD slash YYYY Home PhoneWork PhoneCell PhoneMailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Current Email Address* You will receive a College email account.Emergency Contact InformationName* First Last Relationship*Home PhoneWork PhoneCell Phone Demographic InformationGender*MaleFemaleMarital Status*SingleMarriedWidow/WidowerDivorcedSeperatedWhat is your ethnicity?*Hispanic or LatinoNot Hispanic or LatinoRegardless of your answer to the prior question, please select one or more of the following races that best describe you.*Required for federal reports by Civil Rights Act of 1964. Not used for admission decision. American Indian or Alaska Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White Do you have current or prior military service (includes veteran, active duty, National Guard, and Reserve)?*YesNoAre you a survivor, dependent or a spouse of a 100% disabled veteran or deceased veteran?*YesNoWill you receive their benefits?*YesNoFor required forms, visit newriver.edu/veterans-benefits/.If you are between the age of 16 and 23, do you have a parent who is a member of the Army, Navy, Air Force, Marine Corps, Coast Guard or who is considered active duty? This does not include full-time National Guard duty.*YesNo Citizenship and Residency InformationUS Citizen*YesNoAre you a Permanent Resident?*YesNoA copy of your Permanent Resident "Green" Card is required.Are you a West Virginia Resident?*YesNoHow long have you resided in West Virginia?*Have you resided in West Virginia for the entire past 12 months?*(other than as a college student)YesNo Location and Program InformationAre you applying to receive a WV Invests grant (free tuition)?*YesNoStudent Status applied for:*If your goal is to complete a certificate of applied science or an associate degree program, you should apply as a First-time Freshman, Transfer, or Readmitted student based on the status that best describes you. If your goal is to complete an Advanced Skill Set Certificate, you must apply as a Special Student. Advanced Skill Set Certificates are not eligible for state or federal financial aid. First-time freshman - If you are applying to New River CTC for the first time (even if you took college classes while in high school), and you have not attended another college, as a regular student, and have a high school diploma, GED or TASC, we consider you a first-time freshman. Re-admitted - If you have attended New River CTC in the past but have been absent for one semester or longer (not including the summer term) and have not attempted any other college work since leaving New River CTC, we consider you a returning, readmitted student. High School - Current high school students enrolling at New River CTC for dual or early enrollment. Transfer - If you have earned a high school diploma, GED or Test Assessing Secondary Completion (TASC) and have taken a college course or courses at another college, we consider you a transfer student. Transient - If you are currently attending another college or university but plan to take a class or more at New River CTC to transfer back to your home school, we consider you a transient student. Special - If you wish to take college credit courses for personal enrichment or job improvement and not for the purposes of pursuing a Certificate of Applied Science, Associate of Science or Associate of Applied Science Degree, you may enroll as a special (non-degree or certificate seeking) student.First-Time FreshmanHigh School StudentReturning/ReadmissionTransferTransient/VisitingSpecial (Non-Degree/Non-Certificate Seeking)Degree Interest:*A complete list of certificate and degree programs is available at: newriver.edu/degrees-and-certificates-a-z/. Advanced Skill Set Certificates are not eligible for state or federal financial aid.Non-Degree Seeking or Advanced Skill Set CertificateCertificate of Applied ScienceAssociate of ScienceAssociate of Applied ScienceProgram Interest*Please scroll through the list to select a program.Allied Health ASSCAutomotive Maintenance and Light Repair CASAutomotive Service Technology AASBarbering ASSCBarbering CASBoard Of Governors AASBookkeeping CASBusiness Administration ASBusiness: Accounting AASBusiness: Management AASBusiness: Marketing AASBusiness: Office Technology AASCertified Customer Service Specialist ASSCComputer Science ASComputer Science: Health IT Technician AASComputer Software Application Specialist ASSCComputer Support Specialist ASSCCosmetology CASCriminal Justice: Corrections ASCriminal Justice: Forensic Investigations ASCriminal Justice: Law Enforcement ASCyber Security AASCyber Security CASDiesel Service Technology AASDiesel Service Technology CASElectric Distribution Engineering Technology CASEmergency Medical Services AASEntrepreneurship ASSCEsthetics CASGeneral Studies ASGeneral Welding ASSCHealth Information Management AASHealth Professions Pathways: General Pathway CASHealth Professions Pathways: Health Information Technology CASHealth Professions Pathways: Medical Assisting CASHealth Professions Pathways: Physical Therapist Assistant CASHospitality and Tourism Management AASIndustrial Technology AASIndustrial Technology ASSCIndustrial Technology CASInformation Technology AASIT Foundations CASLegal Assisting AASLegal Office Assistant CASMachining Fabricator CASMachinist ASSCManagement and Supervisory Development CASMassage Therapy CASMedical Assisting AASMedical Insurance Billing and Coding CASMedical Laboratory Technician AASMedical Machine Transcriptionist ASSCNail Care Technician ASSCOccupational Development Child Care Practitioner AASParamedic CASParaprofessional Education AASParaprofessional Education CASPhlebotomy Technician ASSCPhysical Plant Welding ASSCPractical Nursing CASReceptionist ASSCRegistered NursingRetail Department Manager ASSCSocial Services ASTechnical Office Procedures and Skills CASTechnical Sales Specialist ASSCUtility Mechanic ASSCWelding Technology AASWelding Technology CASWhere will you take the majority of classes?*Advanced Technology Center, GhentGreenbrier Valley Campus, LewisburgMercer County Campus, PrincetonNicholas County Campus, SummersvilleRaleigh County Campus, BeaverPlanned Entry Year*Semester*Fall (August)Special Session (Dec.-Jan.)Spring (January)1st Summer (May)2nd Summer (June) High School/High School Equivalency (HSE) and Placement InformationName of high school or GED/TASC center from which you graduated:*State*Date Attended From* Date Format: MM slash DD slash YYYY Date Attended To* Date Format: MM slash DD slash YYYY Diploma*YesNoGraduation Date* Date Format: MM slash DD slash YYYY Do you have Edge Credit (WV students only)?*The EDGE program is an initiative of the West Virginia Department of Education and the West Virginia Community and Technical College System. Students take approved career and technical courses in high school that convert to a variety of college credits offered through community and technical colleges of West Virginia, including New River CTC.YesNoTo request your transcript visit http://careertech.k12.wv.us/edge/takingEdge.htmlWhat placement test(s) have you completed?* ACT SAT Accuplacer at New River CTC None Date Completed Date Format: MM slash DD slash YYYY Placement testing is an admission requirement, used for evaluation and placement. Results will not determine admission. If you have not taken the ACT, SAT or ACCUplacer within 5 years from the date of application, contact the Student Success Center at your location to schedule testing if required. Advanced Technology Center 304.929.6735 Greenbrier Valley Campus 304.647.6591 Mercer County Campus 304.818.2014 Nicholas County Campus 304.883.2465 Raleigh County Campus 304.929.5005 All Previous CollegeTo include all college where you earned dual credit/early enrollment in high school/and or withdrew. Note: you must have your high school, HSE program, and all prior colleges submit your official transcripts to the New River CTC Office of Admissions at the location you will attend if you are degree or collegiate certificate seeking. Transcript(s) must be submitted in their sealed envelope even if you have withdrawn from all coursework.Previous Colleges AttendedNameCity/StateDate Attended FromDate Attended ToDegree EarnedGraduation DateTotal Credits Have you previously attended New River CTC?YesNo Declaration and SignatureNote: A felony or misdemeanor conviction does not automatically disqualify applicants for college admission but may prevent licensure and/or the ability to complete specific programs. Students should speak with the Program Director and/or Instructor for guidance.Have you ever been convicted of a felony or do you have any felony charge(s) pending against you at this time?*YesNoPlease explain:*Have you ever been convicted of a misdemeanor?*YesNoPlease explain:* {all_fields} ConfirmationBy submitting this form, I declare that the information I have supplied on this application is complete, truthful and correct. I further authorize New River Community and Technical College personnel to verify the information given on this application. I understand that omitting previous college information and/or providing false information may lead to dismissal.SignatureDate of Signature Date Format: MM slash DD slash YYYY Last Updated On: 6th January, 2021