Admission Form - Technical Education Center Osceola
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4501 Simpson Rd.
Kissimmee, FL 34744
THE SCHOOL DISTRICT OF OSCEOLA COUNTY, FLORIDA
Tel: 407‐344‐5080
TECHNICAL EDUCATION CENTER OSCEOLA
Fax: 407‐344‐5089
ADMISSION FORM
STUDENT INFORMATION
Please type or print clearly in black or blue ink.
Legal Name:
Maiden Name:
Last
First
Middle
Permanent Address:
Street
City
State
Zip Code
Mailing Address:
(If different from above) Street
City
State
Zip Code
Social Security #:
Date of Birth:
(For 1098T, Tax Credit)
Month
Day
Year
Place of Birth:
Home Phone:
City
State
Country
Country of Citizenship:
Mobile Phone:
Email:
Work Phone:
Gender:
Employment Status:
Adult Student Goal:
Check all that apply:
Male
Employed
Employment
Single Parent
Displaced Worker
Female
Unemployed
Retain Employment
Single Pregnant Woman Displaced Homemaker
Not Applicable
Other
Both
Not Applicable
Resident Status:
Citizenship Status:
Native Language:
Florida Resident
U.S. Citizen
Permanent Resident Alien
English
Spanish
(Copy of card required)
Non‐FL Resident
Non‐Resident Alien
Unknown
Other:
Please Provide the Following Ethnic/Race Data:
This information is requested on a voluntary basis by the U.S. Department of Education.
(Check all that apply)
Are you Hispanic or Latino?
Yes
No
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Will you be attending Technical Education Center Osceola for the first time?
Yes
No
Have you attended any public school in Osceola County?
Yes
No
If yes, please indicate which Osceola County School previously attended.
Have you earned a high school diploma/GED?
Yes
No
If yes, please indicate the State or Country obtained.
Are you a U.S. Veteran?
Yes
No
Emergency Contact:
Contact Phone:
Last
First
Relationship
CERTIFICATION STATEMENT
I CERTIFY that all statements given in this application are true and accurate to the best of my knowledge. I agree to abide by the
Osceola County Student Code of Conduct, copy available upon request. I agree that if my records are not completed within the
initial term of enrollment or if any information is found to be false, I may be suspended from class(es) without a refund of any fees
paid. I understand that reasonable accommodations are available through the Guidance Counselor for students with special needs.
Applicant Signature
Date
An Equal Opportunity Agency
Page 1 of 4
FC‐350‐2462 (Rev. 11/16/11)
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