Apply Online - Mitchell Technical Institute

Want to be a part of Mitchell Tech? Your first step is to apply. We’ve made it easy—just fill out the form, click and you’ll be on your way to a great education. After we receive your application, we’ll ask you for some other stuff like your high school transcript, proof of your birth date, ACT or other test scores, and proof of two MMR immunizations. Once you have these things in place, you’ll pay a $60 matriculation fee to reserve your spot in the program of your choice. What could be easier?

Let’s get started.

NAME
Last Name: *
First Name: *
Middle Name:
Maiden:
Preferred First Name:
Please list all other names that may appear on your academic records:
Social Security Number: *
Are you 16 or older:	Yes No
Date of Birth (optional):
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PERMANENT ADDRESS
Street or Box Number:
City:
State:
Zip Code:
Would you like your mail directed to another address:	Yes No
If you marked "yes", then please complete the following information below:
Current Street or Box Number:
Current City:
Current State:
Current Zip Code:
How long is the current address valid:
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CONTACT PHONE
Home Phone: *
Cell Phone: *
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E-mail: *
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OTHER INFORMATION
Please provide a name of a PARENT, GUARDIAN, OR SPOUSE:
What is the relationship to this person (choose one):	PARENT GUARDIAN SPOUSE
Parent/Guardian Address Street or Box Number:
Parent/Guardian City:
Parent/Guardian State:
Parent/Guardian Zip Code:
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CITIZENSHIP
Please select citizenship type:	USA Permanent Resident Alien Nonresident Alien Refugee / Asylee Other
If you selected "other" please specify:
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PROGRAM / MAJOR
Please enter the name of the program/major:
Desired semester to enroll:
Desired year to enroll (yyyy):
Have you previously applied to MTI:	Yes No
If so, when:
What program:
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EDUCATION
Please fill out the information below as accurately as you can.
High School from which you will or did graduate:
High School City:
High School State:
Date of high school graduation (mm/dd/yyyy):
Have you taken or do you plan to take the ACT:	Yes No
Was a GED taken to earn high school equivalency:	Yes No
If yes, provide the year it was completed:
Select highest grade completed or currently completeing:
If not graduated, do you hold a GED:	Yes No N/A
Name on School Records if different from above (Last, First, Middle, Maiden):
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List previous technical, college or military schooling, including MTI.
Name of School:
City:
State:
Course:
Start Date (mm/dd/yyyy):
End Date (mm/dd/yyyy):
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Name of School:
City:
State:
Course:
Start Date (mm/dd/yyyy):
End Date (mm/dd/yyyy):
__________________________________________________________________________
Name of School:
City:
State:
Course:
Start Date (mm/dd/yyyy):
End Date (mm/dd/yyyy):
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REFERRAL PROGRAM
How did you hear about MTI?:
If referred to MTI by an individual, please share the name and address of the person that referred you. (last name, first):
His/Her Street or Box Number:
City:
State:
Zip Code:
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DEMOGRAPHIC INFORMATION
The following information is regarded as VOLUNTARY. The statistical data helps us maintain accurate records and provides accurate demographic information to various funding and governmental entities.
Gender:	Male Female
Ethnicity:	Hispanic/Latino Not Hispanic/Latino
Race (Select one or more):	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Marital status:	Single Married Divorced Widowed
Do you have children under 18 years of age?:	Yes No
U.S. military veteran:	Yes No
If “Yes,” branch of service:
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I certify that the information in this application is true and complete to the best of my knowledge.
Do you agree with the statement above: *	Yes I agree
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All applications will be automatically dated upon electronic submission.