Ralph R. Willis Career / Technical Center
PO Box 1747, Logan, WV 25601
(304)752-4687 rrwctc.com
Application
Personal Information Please print clearly and press hard
Name ______
LastFirstMiddleMaiden
Mailing address: ______
Number and Street
______
City or TownCountyState Zip Code
Telephone:______E-mail address: ______Driver’s License #______
Social Security Number ______-__ __ -______Date of Birth:______Male Female__
For Reporting Purposes Only:
Marital Status: ___ Married __Single __ Number in household Single Parent __ Yes __ No
Ethnic background (optional) __ Asian/Pacific Islander __ African American__White
___ American Indian/Alaska Native __ Hispanic __ Other
West Virginiaresident: ___ Yes ___No If yes, ___since birth OR ___ since following date:______
U.S. Citizen: Yes No Permanent ResidentResident Alien
If no, what country? ______Visa Type ______Birthplace ______
Educational Information
Career Offering applying for: ______
Sept. Jan. semester Year______, Full-time Part-time Transfer
Are you applying under the West Virginia Board of Regency Program? Yes______No______
High School Attended: ______
School Address
Highest grade completed: (circle one)9101112
Check one:Graduated _____ Will graduate _____ GED ______mo ______day ______year
A copy of your high school transcript or GED test scores must be submitted t before the first day of class to:
Ralph R. Willis Career and TechnicalCenter
Att: Peggy Vance
PO Box 1747, Logan, WV25601
Did you attend a career/technical center? __Yes __ No Name the center ______
Address:______
Did you receive financial aid? __Yes __NoType of aid______
College, Universities or Institutes attended:
Institution ______Degree/credit earned ______yrs. attended______
Institution______Degree/credit earned ______yrs. attended______
A copy of your postsecondary transcript must be submitted before the first day of class to
Ralph R. Willis Career and TechnicalCenter
Att: Peggy Vance
PO Box 1747, Logan, WV25601
Have you attended Ralph R. Willis Career and Technical in the past? Yes No When? ______
Employment Information Work history: Current or most recent job held
Job Title ______Employer ______
Employer address ______
Telephone Number ______Dates: From ___/___/___ to ___/___/___
Financial Aid
How do you plan to finance your education? You must make application and receive conformation of funding before the first day of class or payment of course is necessary.
___PELL Grant___Bureau of Rehabilitation
___Veteran’s Benefits___WIA
___Self Pay___TIA
___Employer ______Other______
Educational Objective What is your educational goal for attending Ralph R. Willis Career/Technical Center
___ Complete a Certificate___ Some Courses/New Job-related Skills
___ Complete a License ___ Some Courses/Personal Growth & Interest
___ Complete a Certificate, then transfer to ___ Upgrade Job Skills
another institution
MAJORS, TYPES OF Certifications AND PREREQUISITES
All programs require a high school diploma or GED to be certified at end of course. See below for program prerequisites. Refer to the center catalog for additional requirements. Please contact the Admission Office to discuss alternatives if you do not meet admission prerequisites.
Course Offerings / Course Registering ForA + Certification- A+ Hardware
MCSE
Air Conditioning/Refrigeration Technology
Automotive Technology-ASE Certification
Collision Repair Technology
Electrical Technology
GeneralBuilding Construction
Graphic Communication
Industrial Equipment Technology
Industrial Electricity Technology
Licensed Practical Nursing
Machine Tool Technology
Plant Systems Technology
ProStart Restaurant Management
Welding Technology
Student Certification
My signature below verifies that information on this application is accurate to the best of my knowledge. I understand that in order to receive Federal, State or Local funding that I must maintain satisfactory progress with my grades and attendance. I also understand that if I withdraw from school and funds can not be obtained that I am responsible to pay all fees, tuition, etc.. under the tuition policy. If student enrolling is under 18, parents resume responsibility.
Student Release Agreement
In order to ensure compliance with statutory provisions regarding coordination of financial aid, I hereby authorize the release of all financial information related to my eligibility, application and awards. If WIA is used to pay tuition/fees because PELL is not yet approved or not sufficient and if additional PELL funds become available, the PELL funds will be used to fully reimburse WIA for the amount paid by WIA for tuition/fees.
______
Applicant’s Signature DateParent/Guardian Signature (if applicant is a minor) Date
It is the policy of Ralph R. Willis Career and Technical Center to comply with all federal, state laws and regulations which prohibit discrimination on the basis of race, color, religion, sex, sexual orientation, national origin or citizen status, age, handicap, marital or veteran’s status in admission to, access to, treatment in or employment in its programs and activities. Inquiries regarding these policies should be directed to the: Affirmative Action Officer, Logan County Schools, 506 Holly Avenue, Logan, WV 25601.