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Commercial Truck Driving Application Form
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Student Information
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Full Name*
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All previous names used:
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Date of Birth*
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Social Security Number*
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Personal Contact Information
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Cell Phone Number*
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Personal Email:*
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Mailing Address*
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Street:
City:
State:
Zip code:
County of Residence:
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Program Date
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Class Choice*
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Statistical Data
THIS INFORMATION IS REQUIRED FOR PURPOSES OF REPORTING TO FEDERAL COMPLIANCE AGENCIES ONLY AND WILL NOT BE USED IN
DETERMINING ADMISSIONS STATUS.
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Legal Gender:*
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Race:*
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Are you Hispanic or Latino?:*
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Did your mother graduate from college?:*
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Did your father graduate from college?:*
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Military Information
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Are you currently active duty, a veteran, a member of the national guard, or a reservist in the US armed forces?:*
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If yes, what branch?:
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Are you a dependent/spouse of an active duty, a veteran, a member of the national guard or a reservist in the
US armed forces?:*
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If yes, what branch?:
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Residency Information
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Are you a US Citizen?:*
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If no, are you a permanent resident?:*
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Choose ONLY ONE of the following options:
Note: This will be used to determine tuition rates and financial aid eligibility.
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- I have lived in the state of Georgia for the last 12 consecutive months?
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- What is your parent/guardian's legal state of residence?
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- How long have they continuously lived in the state listed?
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- I have lived in the state of Georgia for the last 12 consecutive months?
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Previous Education Information
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Have you graduated from High School or obtained a GED?:*
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Have you graduated from college?:*
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Have you attended Chatt Tech previously?:*
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Have you attended another college previously?:*
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If yes, what degree (if any) was earned?
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Required License Upload
Please upload both items below. You are unable to submit the form without both attached.
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(Only the following file types are allowed for upload: JPEG, JPG, PNG, or PDF file)
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GA Driver's License*
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CDL Class A Learner's Permit*
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Acknowledgments
By typing your name and date at the bottom of this form, I am in agreement with the statements that follow:
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- I UNDERSTAND THAT 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 MAY RESULT IN DISMISSAL FROM THE COLLEGE.
- ALL MATERIALS SUBMITTED FOR APPLICATION BECOME THE PROPERTY OF CHATTAHOOCHEE TECHNICAL COLLEGE AND WILL NOT BE RETURNED TO THE APPLICANT.
- I GIVE PERMISSION FOR MY LIKENESS, VOICE, OR COMMENTS TO BE USED IN ANY PROMOTIONAL ITEM ON BEHALF OF CTC.
- I GIVE PERMISSION FOR CTC TO RELEASE INFORMATION TO POTENTIAL EMPLOYERS AS PART OF THE JOB PLACEMENT SERVICE PROVIDED BY THE COLLEGE.
- I UNDERSTAND THAT CTC IS NOT LIABLE FOR ANY EMERGENCY MEDICAL ATTENTION PROVIDED NOR FOR CHARGES INCURRED FROM SUCH.
- I GIVE CTC PERMISSION TO CONTACT ME AT THE TELEPHONE NUMBERS I HAVE PROVIDED VIA ANY MEANS, INCLUDING TEXT MESSAGE OR VOICE.
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Name box:
Date: 12/03/24
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Chattahoochee Technical College is accredited by the Southern Association of Colleges and Schools Commission on Colleges (SACSCOC) to award associate degrees. Chattahoochee Technical College may also may offer credentials such as certificates and diplomas at approved degree levels. Questions about the accreditation of Chattahoochee Technical College may be directed in writing to the Southern Association of Colleges and Schools Commission on Colleges at 1866 Southern Lane, Decatur, GA 30033-4097, by calling (404) 679-4500, or by using information available on SACSCOC’s website (www.sacscoc.org).
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