1. Colleague ID ( Admissions office use only) ________________
Application for RACE CREDIT
Asheville-Buncombe Technical Community College Short Application
340 Victoria Road, Asheville, NC 28801 (828) 398-7900 website: www.abtech.edu
PLEASE PRINT: NAME_____________________________________________________________________
LAST FIRST MIDDLE
ADDRESS CITY STATE ZIP CODE
COUNTY HOME TELEPHONE SOCIAL SECURITY NUMBER
Providing the Social Security number is required for institutional reporting and financial aid purposes. A separate student ID number will be assigned to you upon enrollment.
BIRTHDATE_______________/_______/____________ GENDER:  F  M
Month Day Year
Are you Hispanic or Latino? Yes_____ No_____ (Hispanic/Latino: Mexican, Puerto Rican, Cuban, Central or South
American or other Spanish origin or culture, regardless of race)
RACE (Circle One): 1. American Indian/Alaskan 2.Asian 3. Black or African American
4. Native Hawaiian or Other Pacific Islander 5. White
Emergency Contact Name _____________________________________Phone Number ______________________
High School Attended: _______________________________
Have you ever taken classes at A-B Tech CC _____Yes _____ No
Current Semester: Fall _____ Spring ______ Summer ______ 20___ (year)
___________________________________________________________________________________
Signature of Parent, Legal Guardian, or Holder of Legal Custody Date
___________________________________________________________________________________
Student Signature Date
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
High School course number(s), name ______________________________________________________
ABTCC course number(s), name _____________________________________________________________
CTE Post Assessment Score _________________________ Final Grade _____________________
Expected graduation date _______________________
CDC/Contact: ___________________________________________Phone no. _________________________
Revised 7/23/2013