APPLICATION FOR ADMISSION / READMISSION
An Equal Opportunity Institution – Temple College does not discriminate on the basis
of gender, disability, race, color, age, religion, national origin, or veteran status.
The following information will be used in creating your permanent record. Please print legibly and
answer all questions. Notify the Admissions and Records Office of any changes. Please note that all documents
submitted to the college become part of your official file and cannot be returned. For questions, please call 1-800-460-4636 Ext
8306 or local 298-8306 or see our web page at www.templejc.edu. Please return the application and any other required documents
to:
Temple College
Office of Admissions and Records
2600 South First Street
Temple, TX 76504-7435
I am a returning Temple College student.
Yes
No
I plan to attend Temple College for the following Semester/Year (circle one): FALL SPRING SUMMER Year:_______
PART A: STUDENT INFORMATION
1.
Social Security Number*: __________-_____-__________
(*This information is optional and voluntary. However, your social security number ensures that your documents are matched and processed promptly. Please
note that federal law requires your social security number when applying for financial aid. Also, note that without your social security number, TC will have
difficulty in processing your information so that you might could use the Lifelong Learning or Hope scholarship credit on your income taxes. In addition, TC
will have a difficult time verifying your degrees for future employers. If you do not wish to provide your social security number, please come by the
Admissions and Records office to complete the request for a student identification number.)
2. Name: _________________________________________________________________ 3. Prior Names:_________________
Last Name
First
MI
(Do not use nicknames or initials unless the initials constitute the complete name.)
3. Permanent Address:______________________________________________________________________________________
Street or Route Address
4.
5.
City
State
Zip Code
Mailing Address (if different from Permanent) : ______________________________________________________________
Street or P.O. Box
City
State
Zip Code
Local Home Phone: (______)______-________ 6. Permanent Phone (if different): (______)______-________
7. Work Phone: (______)______-________
9. Date of Birth: _______/_______/________
Month
Day
8. Email address:____________________________________________
10. Gender: 1 - Male 2 - Female
Year
11. Emergency Contact – Name: _____________________________________________
12. Ethnic Origin: *
1 - White-Non-Hispanic
4 - Asian or Pacific Islander
2 - Black-Non Hispanic
5 - American Indian
Phone: (_____)______-________
3 - Hispanic
6 –Non-Resident Alien
*This information is for affirmative action purposes and is optional and voluntary. This information will be used in a non-discriminatory
manner consistent with applicable civil rights laws.
PART B: EDUCATIONAL DATA
13. I am seeking admission to Temple College by the following method:
1 - High School Graduate
4 -College Transfer
2 - GED
5 - Re-enter from Prior Semester at TC
3 - High School Early Admission
6 - Individual Approval
14. Highest Degree or Diploma Held:
0 – None
1 – High School Diploma
2 – Associate Degree
3 – Certificate of Completion (beyond High School level)
4 – Bachelor’s Degree
5 – Beyond Bachelor’s Degree
1 – Associate of Arts Degree at TC. Major:_________________________________________
2 – Associate of Arts Teaching Degree at TC. Major: _________________________________
3 - Associate of Applied Science Degree at TC. Major:_______________________________
4 - Obtain a Certificate at TC. Major:_____________________________________________
6 - Transfer to Another College. Major: __________________________________________
7 - Personal Enrichment
8 - Improve Job Skills
16. High school last attended: ____________________________________________ City/State: _________________________
15. Educational Goal:
(See list on last page
for available majors)
17.
18
19.
20.
21.
22.
Did you graduate? Yes
No If Yes, date: _________________
If No to above, do you have a GED? Yes
No If Yes, date received:________________ Location:_______________
Were you in a Tech Prep Program?
Yes
No
Were you home-schooled?
Yes
No
Are you currently in high school?
Yes
No
If no, please go to question 23.
Will you be attending as an Early Admissions Student or a Dual Credit student?
Early Admissions – You are still in high school and are taking no more than two college courses. Courses are for college
credit only. (Requires a completed Early Admissions Application and high school transcript.)
Dual Credit – You are enrolling in a class which you will earn both high school and college credit. (Requires a
completed Dual Credit Application and a high school transcript.)
23. Colleges Attended: If you have ever attended a college you must complete this section. Failure to list all colleges will be
considered an intentional omission and may lead to enforced withdrawal. List all colleges and universities attended,
INCLUDING TC, beginning with the most recent.
Institution
Location
Dates of
Eligible to
Transfer Inst.
Date of
Attendance
Re-enroll?
FICE Code
Receipt
COLLEGE USE ONLY
24. Classification (at time of enrollment at TC):
1 - Freshman
(0-29 Sem Hrs)
2 - Sophomore
(30-59 Sem Hrs)
8 - Other
(60 or more Sem Hrs)
PART C: TEXAS SUCCESS INITIATIVE STATUS
The Texas Success Initiative assessment test is not used for admission purposes, but must be taken prior to enrollment in any collegelevel courses unless you are exempt or are seeking a Level I Certificate. If you are seeking a degree or are planning to transfer to
another school for a degree, you must take the assessment test prior to enrolling. If you are in high school, you must take the
assessment test prior to enrolling in any college-level courses unless you meet waiver/exemption standards. High school students
enrolling in a Waived Level I Certificate program do not have to take the assessment test but are limited to enrollment in certificate
courses only.
25. Have you taken an Official TSI Assessment Test?
Yes
No If Yes, date of test: ____________________
Name of Test?_______________________________
Please note: Test results are not available immediately after testing; test results may take up to 2 to 3 weeks for results to be available.
26. I have satisfied the Texas Success Initiative requirement at the following institution:_____________________________
27. I am Exempt from Texas Success Initiative assessment test based on:
Associate degree (or higher).
ACT Scores
SAT Scores
TAAS Scores
TAKS Scores
Casual Student – enrolling at TC for personal enrichment or
job skills
Visiting Student – enrolled at a private or out-of-state institution and not seeking a degree from TempleCollege
Transfer from Private/Out of State(must have 9 college – level hours with a 2.0 GPA).
*For more information regarding the
Texas Success Initiative requirements and possible exemptions, please contact the Testing Center at (254) 298-8586.
I authorize Temple College to obtain my THEA or one of the designated test scores and/or my Texas Success Initiative status from National
Evaluation Systems or from any other institutions previously attended. Upon request TC will provide you a copy of the scores. You have the right
to challenge the scores if you feel they are not correct. I understand that I must furnish the TC Admissions Office OFFICIAL copies of my TSI
Assessment test scores PRIOR to enrollment if my test scores are not available electronically. I also understand that I must furnish an OFFICIAL
copy of my transcript from each college and/or high school attended to the TC Admissions Office during the first semester of enrollment if I am
seeking a degree or certificate at Temple College.
I certify that this information is complete and correct to the best of my knowledge. If my application is accepted, I agree to abide by the policies,
rules and regulations of the college regarding conduct and other obligations. I authorize Temple College to verify the information that I have
provided. I further understand that this information will be relied upon by college officials in determining my admission and residence status for
tuition purposes and that submission of false information is grounds for rejection of my application, withdrawal of an offer of acceptance,
cancellation of enrollment, and/or disciplinary action.
____________________________________________________
Signature of Applicant
____________________________
Date
(Revised 5/2005)
Name: _____________________ Date of Birth____________ ID Number_______________
RESIDENCY STATUS INFORMATION
All New and Readmission Students Must Answer the Following Questions
The Texas Higher Education Board Rule 21.38 requires each student to provide substantiating documentation to affirm residence for
tuition purposes. It also requires that they sign an Oath of Residency. All new students or students returning to Temple College after
being out at least 6 months are required to answer the questions below:
PART A. RESIDENCY ISSUES:
1(a) Are you a U.S. Citizen?
Yes
No If No, what country are you a citizen?__________________________
(b) If you are not a citizen, do you hold Permanent Residence status (valid I-551) for the U.S.?
Yes
No
If yes, date permanent resident card* issued:
_______/______/_______ Number: ____________________________
*Please enclose a copy of both sides of the card. Month
Day
Year
2. Are you a member (or dependent of a member) of the U.S. Armed Forces assigned active duty in TX?
Yes
No
(a) Person on active duty:
Self
Spouse
Parent/Legal Guardian
(b) Home of record (State of legal residence): _________________________
(c) Did the member of the U.S. Armed Forces join the military when he/she was a resident of Texas?
Yes
No
*Please note that proof of military assignment or DD 2058 should be filed with the Admissions and Records office.
3. Do any of the following apply to you or parent if parent claims you as a dependent?
(a) Hold title or property (home, land) in Texas
Yes
No
(b) Own business in Temple or Texas
Yes
No
(c) Hold state to or local license to conduct a business or practice profession in TX?
Yes
No
4. Are you a Texas resident?
Yes
No If No, what state are you a resident?__________________
(If you are not a resident of Texas, go to Part B)
5. Upon whom are you basing your claim of residence status?
Self
Parent
Legal Guardian*
If you answer self then you must claim as an independent tax payer, go to question 6 & 7. If you answer parent or legal
guardian then they must claim you as dependent on income tax, go to question 8.
6. If your claim of residence status is based upon yourself answer the following questions:
(a) How long have you resided in Texas? ______________________ Years and _________________Months.
(b) County of residence: _____________________________________________________
(c) Previous State or country of residence: _______________________________________________
(d) If you came here within the past 5 years, why did you move to Texas?
Education
Employment
Other:______________________
7. Are you a Temple resident?
Yes
No
(a) Upon whom are you basing your claim of residence status?
Self
Parent
Legal Guardian*
(b) If your claim of residence is based upon yourself answer the following questions:
(1) How long have you resided in Temple? _______________Years and ________________Months.
(2) County of residence: ________________________________________________
(3) If you came here within the past year, why did you move to Temple?
Education
Employment
Other:______________________
8. If your claim for residence status is based upon parent or legal guardian*, please answer the following questions:
*If Legal Guardian, guardianship papers must be provided.
(a) Name of person upon whom claim is based: __________________________________________________
(b) Relationship to self:
Parent
Legal Guardian
(c) How long has this person resided in Texas? __________________ Years and ________________ months
(d) County of residence: ______________________________________________________
(e) Previous State or country of residence: ________________________________________________
(f) If this person came here within the past 5 years, why did this person move to Texas?
Education
Employment
Other:_______________________
(g) Is this person a U.S. Citizen?
Yes
No
(h) Has parent or legal guardian claimed you as a dependent for U.S. income tax purposes for tax year preceding your
registration?
Yes
No
(i) Will this person claim you for the current tax year?
Yes
No
(j) If claiming In-District Residency, how long has this person resided in Temple? ______________________
PART B: OATH OF RESIDENCY
I understand that information submitted herein will be relied upon by Temple College officials to determine my status for
admission and residency eligibility. I authorize Temple College to verify the information I have provided. I agree to notify the
proper officials of the institution of any changes in the information provided. I certify that the information on this application
is complete and correct and understand that the submission of false information is grounds for rejection of my application,
withdrawal of any offer of acceptance, cancellation of enrollment, or appropriate disciplinary action.
MUST BE SIGNED BY STUDENT ONLY
________________________________________________
__________________________________
Signature of Applicant
Date
My signature above indicates that I acknowledge that I have received the “Important Information about Bacterial Meningitis” material
Please mail or deliver the Residency Information form to Temple College Admissions and Records, 2600
S. 1st. Street, Temple, TX 76504. We will need this information before you register for classes.
RESIDENCE CLASSIFICATION
Verified by:
COLLEGE USE ONLY
1 -- Texas Resident, In-District
3 -- Out of State (Non-Resident)_________
2 -- Texas Resident, Out-of-District________
(Revised 2/2006)