TCAT Pulaski Dual Enrollment Form

Student Information

Personal Email Address (not school email)

First Name

Middle Name

Last Name

Suffix

Preferred Name (if different from First Name)

Have you had any other last names?

Yes

Most Recent Last Name

Birthdate

Age based on DOB

Primary Citizenship

U.S. Citizen or National

Permanent Resident

Political Asylee/Refugee

Reclassification in Progress

Resident Alien

Non-Resident

SSN (no dashes)

Biological Sex

Female

Male

Selective Service: Tennessee law stipulates that all students who are required to register for the federal draft must do so before enrolling in College. By answering yes to this question, I certify that either I have registered for, or I am not required to register for the federal draft. Learn more about Selective Service

Yes

Are you Hispanic or Latino?

Yes

Race

Asian

Black or African American

Native Hawaiian or Pacific Islander

Alaska Native

American Indian

White

May we text you occasionally?

Yes

Cell Phone Number

Phone Number

Mailing Address

Country

Street

City

Region

Postal Code

Hepatitis B (HBV) vaccinations - I have:

Had the entire series of the Hepatitis B vaccine

Elected not to receive the Hepatitis B vaccine

Elected to receive the Hepatits B vaccine and/or am in the process of receiving the complete three dose series of the Hepatitis B vaccine.

Measles, Mumps, and Rubella (MMR) and Varicella vaccinations - I have:

Had the entire series of the MMR and Varicella vaccine

Elected not to receive the MMR and Varicella vaccine

Elected to receive and/or am in the process of receiving the complete series of the MMR and Varicella vaccine

High School Information

High School Level

College

High School

What high school are you attending?

CEEB Code

What is your current grade level?

9th

10th

11th

12th

What month and year are you graduating high school?

Parent Information

Parent's First Name

Parent's Last Name

Parent's Email

Parent's Phone Number

What is the highest level of education your parent/guardian completed within the United States?

High School Diploma, GED, or High School Equivalency

College or Technical Training Beyond High School (less than 2 years)

Associate Degree (2-year degree)

Bachelor’s Degree or Higher (4-year degree or higher)

None of the Above or Unknown

I prefer not to answer

Would you like to provide education information for a second parent or guardian?

Yes

What is the highest level of education your parent/guardian 2 completed within the United States?

High School Diploma, GED, or High School Equivalency

College or Technical Training Beyond High School (less than 2 years)

Associate Degree (2-year degree)

Bachelor’s Degree or Higher (4-year degree or higher)

None of the Above or Unknown

I prefer not to answer

Are you affiliated with the military? (Previously enlisted, currently enlisted, family member...)

Yes

Please select the response that best describes your situation.

Retired from the military with 20 or more years of service

Separated from the military

Currently on active duty with the US military (includes full-time reservists and guard member)

Currently on active duty with the US military AND transitioning

Am a part-time US reservist or guard member

A military spouse

A military family member

Enrollment Information

Which term are you planning to attend?

Summer 2026 (programs starting between May 2026-August 2026)

Fall 2026 (programs starting between September 2026-December 2026)

Have you lived continuously in Tennessee for at least the last 12 months?

Yes

Choose your Dual Enrollment Program?

Lawrence County ISC - CNC Machining Technology - Day

Lawrenceburg - Building Construction Technology - Day

Lawrenceburg - Residential Wiring and Plumbing - Day

Lawrenceburg ISC - Pharmacy Technology - Day

Lawrenceburg ISC - Welding Technology - Day

Marshall - Administrative Office Technology - Day

Marshall - CNC Machining Technology - Day

Marshall - Industrial Maintenance Technology - Day

Marshall - Welding Technology - Day

North Lawrence - Building Construction Technology - Day

Pulaski - Administrative Office Technology - Day

Pulaski - Advanced Manufacturing Education - Day

Pulaski - Automation, Process, and Prod Sys - Day

Pulaski - Building Construction Technology - Day

Pulaski - CNC Machining Technology - Day

Pulaski - Computer Operating Systems and Networking

Pulaski - Computer OS Networking Cybersecurity - Day

Pulaski - Criminal Justice: Correctional Officer - Day

Pulaski - Digital Agronomy - FT Day

Pulaski - Electrical Plumbing Construction Technology - Day

Pulaski - Heating Vent Air Condition Refrig - Day

Pulaski - Heating Vent Air Condition Refrig - Evening

Pulaski - Industrial Electricity - Day

Pulaski - Industrial Maintenance Technology - Day

Pulaski - Industrial Maintenance Technology - Evening

Pulaski - Pharmacy Technology - Day

Pulaski - Welding Technology - Day

Pulaski - Welding Technology - Evening

S. Lawrence - Building Construction Technology - Day

South Lawrence - Residential Wiring and Plumbing - Day

South Lawrence - Welding Technology - Day

Where does TCAT fall in your choices to begin classes after high school graduation?

1st choice (I'm definitely coming to TCAT)

2nd choice (I'm still considering my options but keeping TCAT as a strong possibility)

3rd choice (I will likely go elsewhere)

I understand that withholding information requested on this application, including attendance at any other institution, or giving false information may make me ineligible for admission at the college or subject to dismissal. I have read this application and certify that the statements I have made on this application are correct and complete, including a report of all college work attempted or completed.

In place of your signature, please type your full legal name:

2024 TPUL

Dual Enrollment - if you are a high school student interested in earning college-level credit before graduation.

Generate PIN

Yes

Submitted Flag

Yes

Always Create New Round

Yes

Set Relationship Type