ALL QUESTIONS MARKED WITH A RED ASTERISK * ARE REQUIRED TO BE ANSWERED.

PLEASE PRESS THE TAB KEY TO NAVIGATE BETWEEN FIELDS. PRESSING THE ENTER KEY MAY DELETE ANY ENTERED INFORMATION.

PERSONAL INFORMATION

LEGAL FIRST NAME

LEGAL MIDDLE NAME

LEGAL LAST NAME

PREVIOUS LAST NAME(S)

DATE OF BIRTH (Ex. 01/01/1999)

SOCIAL SECURITY NUMBER

   Your social security number is important for tax credit purposes

EMAIL ADDRESS

PLEASE CONFIRM EMAIL ADDRESS

CELL PHONE NUMBER

REQUESTED FHTC PASSWORD

Passwords Requirements:

   - Between 8 and 20 characters long
   - Contain at least 1 lowercase letter
   - Contain at least 1 uppercase letter
   - Contain at least 1 number
   - May contain the following special characters: $ @ ! % * ? & # ^ ( ) . < > { } ` ~ ' " + _ -

PLEASE CONFIRM FHTC PASSWORD

HAVE YOU PREVIOUSLY ATTENDED FLINT HILLS TECHNICAL COLLEGE?

This includes classes or workshops which you may have taken several years ago

MAILING ADDRESS

STREET ADDRESS

CITY

STATE

ZIP CODE

COUNTY

COUNTRY

PERMANENT ADDRESS

STREET ADDRESS

CITY

STATE

ZIP CODE

COUNTY

COUNTRY

EMERGENCY CONTACT INFORMATION

NAME

PHONE NUMBER

STATISTICAL INFORMATION

This information will only be used to fulfill state reporting requirements.

GENDER

MARITAL STATUS

ETHNICITY

RACE

ARE YOU A FIRST GENERATION COLLEGE STUDENT?

You would be considered a first generation college student if your parents or grandparents did not attend college.

CITIZENSHIP AND RESIDENCY

CITIZEN OF

CITIZENSHIP STATUS

MILITARY SERVICE AND NATIONAL GUARD

WILL YOU BE APPLYING FOR GI BILL BENEFITS?

ARE YOU A VETERAN?

MILITARY BRANCH

ARE YOU AN ACTIVE DUTY MILITARY SERVICE MEMBER?

MILITARY BRANCH

ARE YOU MEMBER OF THE NATIONAL GUARD?