Western Admissions Application Form

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Western Admissions Application Form

Western requires a one-time, non-refundable $30 application fee. Send check (made payable to Western) to Western Technical College, Attn: Admissions Office, P.O. Box C-0908, La Crosse, WI 54602-0908. If you wish to pay by credit card, please call 608.785.9084. If you have previously attended Western and paid an application fee, you are not required to submit payment. If you are not sure if you have previously paid, Admissions will check upon receipt of your application and notify you.

Items marked with an asterisk(*) are required fields. Items with errors will turn red after you leave the field--please correct any red fields before continuing.

Please Note: You will be able to print a confirmation copy of the application (printable copy will appear on your screen) after all the required fields (in *bold) are successfully submitted.

First Time Here?

*Have you attended Western before?

If yes, Student ID (if known), semester and last year attended must be filled out:

Student ID

Semester

Year

Legal Name:

*First Name

*Last Name

Middle Name

Former Last Name: (if applicable)

Permanent Address:

*Address

*City

*State

*Zip Code

Mailing Address: (if different)

Address

City

State

Zip Code

Contact Information

*Phone Number

*Email

*Re-enter Email

About You

*Gender

*Social Security Number
(Social Security numbers are used for record keeping and statistical purposes and are kept in strict confidence. See our Privacy Statement for more information on our privacy policies).

*Date of Birth:

*U.S. Veteran

*Are you a U.S. citizen or permanent resident?

If not, provide the following Visa information:

U.S. Visa Type:

U.S. Visa Number:

*I am a legal resident of

*City, Village or Township Name:

*County:

*State:

*Name of high school district in which you now reside:

Parent Information

*Parents completed a four-year college or beyond.

Ethnicity

The following questions are confidential. Your responses will help the technical college evaluate recruitment and retention practices and will not affect admission to the college.
*Are you Hispanic or Latino?

Racial Identity: Select the racial group or groups that apply to you.

	American Indian or Alaska Native
	A person whose ancestors include native peoples of North and South America (including Central American), and who maintains a tribal affiliation or community attachment.
	Asian
	A person whose ancestors include native peoples of the Far East, Southeast Asia or the Indian subcontinent (including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam).
	Black or African American
	A person whose ancestors include any of the black racial groups of Africa.
	Native Hawaiian or other Pacific Islander
	A person whose ancestors include the native peoples of Hawaii, Guam, Samoa or other Pacific Islands.
	White
	A person whose ancestors include native peoples of Europe, the Middle East or North Africa.
	Other

Western Technical College Information

*Application Type

If re-entry or changing programs, do you wish to be discontinued from your current program? If yes, please indicate program.

Program to Discontinue

*Which Campus (location) you wish to attend:

Semester/Year You Want To Attend

*Semester

*Year

Program Choice

At least one program or certificate needs to be selected in this section. If you are unsure, select the program that interests you the most.

Note: If you are applying for a certificate program, select from the Certificate Program drop-down list. You will need to contact the division indicated in parentheses to notify them of the particular certificate in which you are interested.

*Program Choice

Certificate Programs

High School Information

*Name of last high school attended:

*City

*State

*Zip Code

*High School Graduate/Current High School Student?

Graduation Date or Expected Graduation Date:

Month

Year

If you did not complete high school and receive a diploma, have you completed a (select one)?

Month

Year

GED/HSED received from:

*Have you taken a high school course that might be counted for technical college credit (such as Youth Apprenticeship, Certified Nursing Assistant, Certified Co-ops)? (You must provide a transcript or certificate to verify credit earned.)

*Did you complete the Wisconsin Covenant program, or if you are a current high school student, are you a Covenant Scholar?

*Select highest grade completed:

Previous colleges and universities attended

You must provide an official transcript to request credit transfer.

First College or University Attended:

Name:

City:

State/Province:

Dates Attended: (from/to)

Date Graduated:

Second College or University Attended:

Name:

City:

State/Province:

Dates Attended: (from/to)

Date Graduated:

Third College or University Attended:

Name:

City:

State/Province:

Dates Attended: (from/to)

Date Graduated:

Fourth College or University Attended:

Name:

City:

State/Province:

Dates Attended: (from/to)

Date Graduated:

Comments

Comments (250 character max)

Certify

*I certify that the information on this application is true and complete to the best of my knowledge.

*Date

*Name

Western Admissions Application Form

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