APPLICATION FOR 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. 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
1-800-460-4636 Ext 8306
I plan to attend Temple College for the following Semester/Year (circle one): FALL SPRING
SUM I
SUM II
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. Emergency Contact – Name: _____________________________________________
Phone: _________________________
4.
Permanent Address:______________________________________________________________________________________
Street Address
City,
State
Zip Code
5. Permanent Phone: (______)______-________ 5. Local Phone: (______)______-________
6. Work phone: (______)______-________
7.
Mailing Address if different from above: _____________________________________________________________________
Street or P.O. Box
City,
State
Zip Code
8.
Date of Birth: _______/_______/________
Month
Day
9. Gender: 1 -
Male 2 -
Female
Year
10. Ethnic Origin: *
1 - White-Non-Hispanic
4 - Asian or Pacific Islander
2 - Black-Non Hispanic
5 - American Indian
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
11. I am seeking admission to Temple College by the following method:
1 – High School Graduate
6 – Re-enter from Prior Semester at TC
2 – High School Early Admission
7 – College Transfer – Not seeking Degree or Cert. at TC
3 – GED
8 – Individual Approval
5 – College Transfer To TC – Degree/Cert. Seeking at TC
12. 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
(Revised 1/2002)
13. Educational Goal:
(See list on last page
for available majors)
1 - Associate in Arts Degree at TC. Major:______________________
2 - Associate in Applied Science Degree at TC. Major:____________
3 - Obtain a Certificate at TC. Major:__________________________
6 - Transfer to Another College. Major: ________________________
7 - Personal Enrichment
8 - Improve Job Skills
CODE:____________
CODE:_____________
CODE:_____________
CODE:_____________
Office Use:
14. Colleges Attended Since Leaving TC: 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 since leaving TC beginning with the most recent.
Institution
Location
Dates of
Attendance
15. Current Classification:
1 - Freshman
(0-29 Sem Hrs)
Eligible to
Re-enroll?
Transfer Inst.
Date of
FICE Code
Receipt
COLLEGE USE ONLY
2 - Sophomore
(30-59 Sem Hrs)
8 - Other
(60 or more Sem Hrs)
Office Use:
PART C: TASP STATUS
The TASP Test is not used for admission purposes, but must be taken prior to enrollment in any college-level courses unless you are
exempt or are seeking a Level-One Certificate. If you are seeking a degree or are planning to transfer to another school for a degree,
you must take the TASP Test prior to enrolling. If you are in high school, you must take the TASP Test prior to enrolling.
16.. Have you taken the Official TASP Test?
Yes
No
If Yes, date 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.
17. I have satisfied the TASP requirement at the following institution:_________________________________
18. I am Exempt from TASP test based on:
Credit earned prior to Fall 1989 or Bachelor’s degree
ACT Scores
SAT Scores
TAAS Scores
*For more information regarding the TASP test and possible exemptions, please contact the Counseling office at (254) 298-8331.
I authorize Temple College to obtain my TASP scores and/or my TASP status from National Evaluation Systems or from any other
institutions previously attended. I understand that I must furnish an OFFICIAL copy of my transcript from each college and/or high
school attended to the Admissions Office at TC during the first semester of enrollment. I also understand that I must furnish the TC
Admissions Office OFFICIAL COPIES of my TASP scores PRIOR to enrollment if scores are not available electronically. 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 1/2002)
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 in Texas should be filed with the Admissions and Records office.
3. 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)
4. Upon whom are you basing your claim of residence status?
Self
Parent
Legal Guardian*
If self, go to question 5. If parent or legal guardian, go to question 7..
5. 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:______________________
6. 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:______________________
7. 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.
________________________________________________
__________________________________
Signature of Applicant
Date
My signature above indicates that I acknowledge that I have received the “Important Information about Bacterial Meningitis” material.
RESIDENCE CLASSIFICATION
Verified by:
COLLEGE USE ONLY
1 -- Texas Resident, In-District
3 -- Out of State (Non-Resident)_________
2 -- Texas Resident, Out-of-District________
5 -- Foreign_________
(Revised 1/2002)
Educational Goal
TASP Waived Certificates
Child Development Associate Preparation
Early Childhood
Child Care and Development Administration
Repair Technician Option
Network Administration Option
Microcomputer Application Specialist
Microcomputer Applications Technology
Business Application Development
Criminal Justice: Peace Officer
Automotive Service Technician
Basic Parts Services
Driveability
CAD Mechanical Design
Computer-Aided Design
CAD Auto CAD (pending approval)
CAD Printed Circuit Board Design (pend appl)
Geographic Information Systems (pend appl)
Intermediate EMT
Surgical Technology
Vocational Nursing
Small Business Management
Management
Office Management
Administrative Assistant
Industrial Tech: Electronic Systems
Industrial Tech: Mechanical Systems
Industrial Tech: Welding Fundamentals
Industrial Tech: Industrial Supervision
Cisco
Database Specialist
1-6-7-8
Agriculture
Art
Business Education
Biology
Chemistry
Criminal Justice
Economics
Elementary Education
Education, General
Education, Secondary
Engineering
English
Government
History
Journalism
Law (Pre)
Mathematics
Medicine (Pre)
Music
Nursing (BSN)
Pharmacy
Physical Education
Physical Therapy
Physics
Psychology
Sociology
Spanish
Speech
Theatre
For 1,6 Undecided
For 7,8 Undecided
0101
1002
0838
0401
1905
7021T
2204
0802
0801
0803
0901
1501
2207
2205
0602
1401
1701
1206
1004
1203
1211
0835
1212
1902
2001
2008
1105
1506
1007
9999
8888
5222A CDAC
5222B CECC
5222C CCDA
6021F CIMR
6133C CINO
6133A CIMA
6021C CIAT
6021D CIBP
7021A CJPC
6422A AUAT
6422B AUBP
6422C AUDC
8622E DFMD
8622C DFTG
8622F DFAC
8622G DFCB
8623A GISA
8040A EMTI
8031A STTS
7821 NURS
5621B MGSB
5621A MGTE
5822A OIOM
5824B OIOI
8441C INBE
8441D INMS
8441G INWT
8441E INIS
6021G ITCC
6021H IDBE
Vocational/Technical Major Codes
AAS Automotive Service & Management 6422
AAS Child Development 5222
AAS Computer Aided-Design 8622
AAS Criminal Justice 7021
AAS Network Administration Option 6133W
AAS Microcomputer Repair Technician 6021R
AAS Web Technology 6023
AAS Microcomputer Applications Technology Opt 6021
AAS Business Application Development 6021E
AAS Dental Hygiene 8034
AAS Emergency Medical Services Technology 8040
AAS General Business 5822
AAS Geographic Information Systems
AAS Industrial Technology 8441
AAS Management 5621
AAS Medical Laboratory Technology 8028
AAS Nursing 8021
AAS Respiratory Care 8025
Vocational/Technical Level-II Certificate Major Codes (TASP Required)
Paramedic EMT Beginning Fall 2000
8040C EMTP2
Web Technology
6023A CIMW
(Revised 1/2002)