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	Commercial Truck Driving Application Form
Student Information
Full Name*
All previous names used:
Date of Birth*
Social Security Number*
Personal Contact Information
Cell Phone Number*
Personal Email:*
Mailing Address*
Street: City: State: Zip code: County of Residence:
Program Date
Class Choice* Choose one... Summer: June 10 (Day class)
Statistical Data THIS INFORMATION IS REQUIRED FOR PURPOSES OF REPORTING TO FEDERAL COMPLIANCE AGENCIES ONLY AND WILL NOT BE USED IN DETERMINING ADMISSIONS STATUS.
Legal Gender:*	Choose one... Male Female
Race:*	Choose one... American Indian or Alaskan Native Asian Black Native Hawaiian or Pacific Islander White
Are you Hispanic or Latino?:*	Choose one... Yes No
Did your mother graduate from college?:*	Choose one... Yes No Unknown
Did your father graduate from college?:*	Choose one... Yes No Unknown
Military Information
Are you currently active duty, a veteran, a member of the national guard, or a reservist in the US armed forces?:*	Choose one... Yes No
If yes, what branch?:	Choose one... MAF Military Active Air Force MAA Military Acitve Army MAC Military Active Coast Guard MAM Military Active Marine MG Military Active National Guard MAN Military Active Navy MR Military Reservist MV Military Veteran
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?:*	Choose one... Yes No
If yes, what branch?:	Choose one... RAFF Dependent/Spouse Active Air Force RAA Dependent/Spouse Acitve Army RAC Dependent/Spouse Active Coast Guard RAM Dependent/Spouse Active Marine RG Dependent/Spouse Active National Guard RAN Dependent/Spouse Active Navy RR Dependent/Spouse Reservist RV Dependent/Spouse Veteran
Residency Information
Are you a US Citizen?:*	Choose one... Yes No
If no, are you a permanent resident?:*	Choose one... Yes No
Choose ONLY ONE of the following options: Note: This will be used to determine tuition rates and financial aid eligibility.
I am 24 years old or older
- I have lived in the state of Georgia for the last 12 consecutive months? Choose one... Yes No
I am under 24 years old and my parents/guardians claimed me on their most recent tax return
- What is your parent/guardian's legal state of residence?
- How long have they continuously lived in the state listed?
I am under 24 years old and no one claimed me on their most recent tax return
- I have lived in the state of Georgia for the last 12 consecutive months? Choose one... Yes No
Previous Education Information
Have you graduated from High School or obtained a GED?:* Choose one... Yes No
Have you graduated from college?:* Choose one... Yes No
Have you attended Chatt Tech previously?:* Choose one... Yes No
Have you attended another college previously?:* Choose one... Yes No
If yes, what degree (if any) was earned? Choose one... No degree Associate Degree Bachelor's Degree
Required License Upload Please upload both items below. You are unable to submit the form without both attached.
(Only the following file types are allowed for upload: JPEG, JPG, PNG, PDF, or Word file)
GA Driver's License*
CDL Class A Learner's Permit*
Acknowledgments By typing your name and date at the bottom of this form, I am in agreement with the statements that follow:
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.
Name box: Date: 05/19/24
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).
Submit CDL Application