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1200 Fair Street, Chillicothe, MO 64601
660.646.3414

Since this web site is not secure, please complete this form online
and
then PRINT it to mail or FAX (fax 660 646 3568) to the GRTS.

You may also download this application as a PDF file and print, complete, and mail.
Download as a Word document here.

GENERAL INFORMATION
*Indicates Optional

NAME (Last, First, MI):

SOCIAL SECURITY #:
DATE TO START SCHOOL:
ADDRESS:
CITY:
STATE:

 

ZIP CODE:

TELEPHONE:

(Include Area Code)

CELL PHONE:

(Include Area Code)

E-MAIL:

CONFIRM E-MAIL:

HOW DID YOU HEAR ABOUT GRTS?:

PERSONAL INFORMATION
The following information will be used to assist you and/or for state and federal reporting.

SEX:

Male   Female

*ETHNIC ORIGIN:
(Optional)

IF OTHER SELECTED ABOVE:

CITIZENSHIP:

DATE OF BIRTH:

VETERAN:

Yes   No

*MARITAL STATUS:
(Optional)

Married   Single  Divorced
*SINGLE PARENT:
(Optional)
Yes   No

*KNOWN DISABILITIES:
(Optional)

EDUCATIONAL BACKGROUND

HIGH SCHOOL ATTENDED:
(NAME, CITY, STATE)

GRADUATION DATE:

 DATE GED Received:
(High School Equivalence)
(Copy must be attached)

Are you/will you be certified eligible through the A+ Schools program? Yes No 
(Transcript with A+ seal must be submitted
.)

PREVIOUS POST SECONDARY/COLLEGE TRAINING RECEIVED:

Name of College:

Date Attended:
Name of College:
Date Attended:
PROGRAMS OFFERED

PROGRAM YOU WISH TO ENROLL IN:

If you selected Health Occupations, please list the health program for which you are applying:

I plan to pursue the Associate of Applied Science Degree upon completion of my chosen program. Yes No 

Grand River Technical School publishes promotional materials as a part of its outreach activities. Do you give permission for your picture to be used in various promotional items such as the GRTS website, brochures, etc.? Yes No 

I give permission to release my GRTS transcript to prospective employers upon their request. Yes No

I grant permission for the following parents/stepparents/guardian to be given information (ie: grades/financial aid) if requested: (Dependent students under 21, please provide names of those who may request this information)

I understand that as a condition of my acceptance to GRTS, a criminal background check will be completed.
Please sign in the space below after you print this form prior to mailing or faxing.

Student Signature:

Date:

Emergency Contact:

Relationship:

Emergency Contact Telephone: (Include Area Code)
Emergency Contact Cell #:

(Include Area Code)

ENROLLMENT PROCEDURES
  1. Tour the school and program of your choice.
  2. Submit application and $50 non-refundable application fee to school. (Fee will be applied to tuition.) NOTE: The application fee for EMT and Paramedic is $100.
  3. Have a copy of your official FINAL high school transcript (or GED) and any post-secondary transcripts sent to GRTS.
  4. Schedule appointment for admissions testing.
  5. Pass criminal background check.

EMT and Paramedic students should contact the school for additional enrollment pre-requisites and application fees.

It is the policy of Grand River Technical School that no person shall, on the basis of race, sex, creed, color, or disability, be subject to discrimination in employment, or in admission to any program or activity of the school. Direct questions to Superintendent, EEO/AA Coordinator, P.O. Box 530, Chillicothe, MO 64601.

In compliance with Title IX of the Americans with Disabilities Act, Grand River Technical School will provide reasonable accommodations to disabled persons upon request. Requests should be directed to:  Director, GRTS, 1200 Fair Street, Chillicothe, MO 64601; (660) 646-3414.

Since this web site is not secure, please complete this form online
and print it to mail or FAX (fax 660 646 3568) to the GRTS. Be sure to include your signature.

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This page updated by BK Web Works 08/10/2016.