Application for Admission
Fill out all sections of the application that apply to you.
When finished, click the submit button at the bottom of the page.
TIP: You can use the Tab key to move between fields.
Social Security Number
--
 
Last Name First Name MI
 
Previous Name
If you have ever gone by a different name than the one above (i.e. Maiden Name) please enter it below.
 
Sex Birth Date (mm/dd/yyyy)
Male Female //
 
Race (Please select one)
Asian or Pacific Islander  American Indian  Black
Hispanic   White  Alaskan Native
 
Present Street Address
   
City State Zip
County Phone Number
--
 
Permanent Street Address
Same as Present Address    
Address    
   
City State Zip
County Phone Number
--
  
In Case of Emergency Please Contact...
Address (Same as my Present Address)
   
City State Zip
Relationship to You Phone Number
--
 
Citizenship (Please Select One)
U.S. Citizen Permanent Resident
Foreign Citizen
(not a Permanent Resident)		  
If you are a foreign citizen, you must provide all of the following information:
  Country of Citizenship: 
  Country of Birth: 
  Visa Type
  Native Language
  All applicants whose native language is not English must submit a score on the Test of English as a Foreign Language (TOEFL).
Non-citizens must provide a copy of their visa or alien registration card.
 
Residency Status for Fee Purposes
Have you lived in Tennessee continuously since birth? Yes  No
If no, how long have you lived in Tennessee? Years:   Months:
Why did you move to Tennessee?
 
 
Employment
Company Name
City State

Length of Employment Phone Number Employment Status

From:
  MM YYYY
  Presently Employed Here

To:
  MM YYYY
-- Full-time  Part-time
 
Classification
Registration Type (check one)
First Time College Student
Transfer Student (from another college)
Transient Student (transferring VSCC credit back to the institution you are currently attending)
Returning/Readmitting VSCC Student
Enrollment Term (select one)
Course of Study
(Please pick one)		 Major/Concentration
(Please select one from the list next to your Course of Study)

(University Parallel Degree)
 
Planned Course Load (check one)
Full Time (12 or more credit hours per semester)
Part Time (Less than 12 credit hours per semester)
Additional Classification (check all that apply)
English as a Second Language (ESL)
Veteran of the U.S. Armed Forces
Senior Citizen
Attendance Time (check one)
Day Classes (including video courses)
Night Classes
Primary Attendance Site (choose one)
I will attend classes mostly at the site.
 
High School Information
Official high school transcripts and GED Scores (if applicable) are required and must be sent to the Admissions Office.
High School Name
City State
Check one of the following
High School Graduate (including all students who anticipate graduation at a later date)
  Graduation Date
    MM YYYY
Received a GED
  Date GED Received
    MM YYYY
   
Neither apply to my situation.  Please Explain:
Testing Information
Have you taken the ACT (American College Test)? Yes  No
Have you taken the SAT (Scholastic Aptitude Test)? Yes  No
 
Previous Colleges/Universities
List all colleges/universities previously attended.  Please list most  recent college first.
(Official transcripts from each institution are required and must be sent to the Admissions Office.)
Name of College/University 1
City State
Dates Attended Degree Earned
From To
 
MM YYYY MM YYYY  
Name of College/University 2
City State
Dates Attended Degree Earned
From To
 
MM YYYY MM YYYY  
Name of College/University 3
City State
Dates Attended Degree Earned
From To
 
MM YYYY MM YYYY  
Based on the last college you attended:
Are you on probation? Yes  No

If Yes, Date:
  MM YYYY
Are you on suspension? Yes  No

If Yes, Date:
  MM YYYY
Is your suspension a Developmental Studies suspension? Yes  No

If Yes, Date:
  MM YYYY

 
Draft Certification (only male students need to complete this section
Chapter 579 of the State of Tennessee Public Acts of 1984 provides that "no person who is required to register for the Federal Draft shall be eligible to enroll in any State Post-Secondary school until such person has registered for the draft."  To comply with this legislation, please select the the condition below that applies to you:
  I certify that I am registered with the Selective Service.
  I was born before 1960.
  I am not yet 18 years old.
  I am in the Armed Forces on Active Duty
  I am not required to register with Selective Service since I am a permanent resident of the Trust territory of the Pacific Islands or the Northern Mariana Islands.
If you have not registered with Selective Service and are required to do so , you may register online at http://www.sss.gov.
 
Information for Persons with Disabilities
If you are in need of accommodations or accessibility assistance due to a disability, please contact the Disability Services Office in Campus Center 206 B or call 615-230-3472 or toll-free at 1-888-335-8722 extension 3472; TDD: 615-230-3488.
 
 

Disclaimer: Volunteer State Community College will observe strict confidentiality when dealing with your submitted information, but you need to be aware that it is possible for your information to be electronically intercepted illegally. Exercise due caution whenever transmitting personal information.