Application for Readmission
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
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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
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Permanent Street Address
Same as Present Address    
Address    
   
City State Zip
County Phone Number
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In Case of Emergency Please Contact...
Address (Same as my Present Address)
   
City State Zip
Relationship to You Phone Number
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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)
Returning/Readmitting VSCC Student
Enrollment Term (select one)
Course of Study Major/Concentration
(Please select one from the list next to your Course of Study)
Associate of Arts or Science
(University Parallel Degree)
Associate of Applied Science
(Two-Year Career Degree)
Technical Certificate
(Fast-Track Career Program)
Note: Degree-seeking students who are applying for Financial Aid must specify a major.
Non-Degree Seeking
Special High School Student
Dual Enrollment High school juniors or seniors taking college level courses during the day.  May be taught on high school campus.
Early Admission Will enter VSCC after completing junior year in high school.
Joint Enrollment High school senior enrolled at VSCC and high school at the same time.
Advanced Studies Will attend VSCC summer term between junior and senior year of high school.
Academically Talented/Gifted Grades 9, 10, 11, or 12
 
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