Admissions Application Request - Main Form

Contact Information
Personal Information
Address
Parent Information
Academic Information
Additional Information

is required

is Required

First Name
Middle Name
Last Name
Maiden Name
Suffix
Email Address
Social Security Number

Confirm Social Security Number
Date of Birth
Gender
Are you Hispanic or Latino?
Select one or more of the following races:

White

Black or African American

Asian

American Indian or Alaska Native

Native Hawaiian or Other Pacific Islander
Citizenship Status
By providing your mobile number and checking this box, you agree to receive text messages from us. Standard messaging rates may apply. You can opt out at any time by replying STOP to any message you receive.

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Contact Information
Country
Street 1
Street 2
City
County
State
Zip Code Zip Code Extension
Province
Postal Code
Mobile Phone Mobile Phone Area Code Mobile Phone Exchange Mobile Phone Number Mobile Phone Extension Ext:
Mobile Phone Mobile Phone Extension Ext:

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Emergency Contact Information
Emergency Contact Relationship
Emergency Contact First Name
Emergency Contact Last Name
Emergency Contact Email
Emergency Contact Mobile Phone Number Emergency Contact Mobile Phone Number Area Code Emergency Contact Mobile Phone Number Exchange Parent 1 US Phone Number Emergency Contact Mobile Phone Number Extension Ext:

is Required

Highest Level of Education
Last High School Attended
College Name
College Name
Program of Interest
Anticipated Starting Semester
Are you a Veteran?
Will you be a high school student when you attend this program?
If your highest level of education was college, please indicate the degree you earned

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Today's Date (mm/dd/yyyy)
Signature (Please type your full name)
How did you hear about us?

Counselor

Driving by/Sign

Email

Friend/Family Member

High School

Newspaper Ad

Other

Phone Book

Radio

Received Schedule in Mail

Television

Website
Military Code
Is English your primary language?
Which best describes your current status?
Prefix
If no, what is your primary language?
Did either of your parents receive a college degree?
Which Medical Assistant Class would you like to take?
What Intravenous Therapy for Medical Assistants session would you like to attend?
Would you like to take the morning or afternoon class for this program?
Which Patient Care Technician Class would you like to take?
Which Carpentry class are you interested in attending?
If you will still be in high school while attending a program with TCR, please enter your Parent/Guardian information and choose the Parent/Guardian relationship.
This class is only available to current certified Medical Assistants. Can you provide proof that you are a current Medical Assistant?
If you are still in high school, please choose "Parent/Guardian".
Which Phlebotomy Session would you like to take?
Are you interested in morning, afternoon, evening or online/hybrid classes?
You must have a valid Colorado Emergency Medical Technician license to take this class.
There are no more seats available for the Fall Sessions. Please choose the Spring semester to see available dates.
Please select the Welding session you would like to attend.
What Intravenous Therapy for Medical Assistants session would you like to attend?

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