Application

Program

Please select a program you are interested in.

Program

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Personal Information

First Name

Enter a first name

Middle Name

Last Name

Enter a last name

Suffix

Enter an email

Birthdate

Enter a birthdate (MM/DD/YYYY)

Privacy Act Notice:
The College confidentially maintains your Social Security Number(SSN) or Individual Taxpayer Identification Number(ITIN) for routine uses such as, facilitating document matching, verifying your identity, and expediting your enrollment and financial aid. Disclosure of your SSN or ITIN is voluntary, but failure to provide your SSN or ITIN may result in confusion regarding your identity, and once admitted, could result in delay or loss of federal and state financial aid, tax credits, student loan deferments, veteran benefits, and other benefits under law. If you do not wish to disclose your SSN or ITIN number on this form, or if you do not have an SSN or ITIN number, please contact the college for assistance in completing your application.

I have read the Privacy Act Notice Must accept to proceed

SSN or ITIN?

SSN ITIN

SSN

Enter an SSN

ITIN

Electronic delivery of 1098-T

Yes No

Select an option

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Contact Information

Please enter your current residential address or the primary address where you receive mail.

Address Line 1

Enter an address

Address Line 2

City

Enter a city

State

Select a state

Zip Code

Enter a zip

Mobile Phone

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Home Phone

Which state do you permanently reside in?

Select a state

Emergency Contact Name

Emergency Contact Phone

Phone Type

Relationship

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Demographic Information

Gender

Male Female

Select your gender

Are you Hispanic or Latino?

Yes No

Select one or more of the following races:

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

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Finish Application

Password:

The following password will be used to login to the Portal.

Password must be at least 8 characters.
Password is case sensitive.
Avoid using the same password for multiple sites.

Password

Enter a password

Confirm Password

Confirm password

By completing this application, I confirm that I understand and agree that I will be jointly enrolled at
Southwest Technical College and Southern Utah University, I will be receiving credit at Southern Utah
University, at no charge to me, for any coursework that I complete at Southwest Technical College, which meets the dual enrollment partnership requirements; and that I understand and give my permission for Southwest Technical College and Southern Utah University to share my educational records with each other to facilitate the granting of university credit and related purposes.
I further understand that I may complete this application, and then opt out of involvement with the dual enrollment agreement between Southwest Technical College and Southern Utah University at any time. I understand that the procedure to opt out of involvement is to complete a written form at Southwest Technical College Student Services. I understand that if I opt out, I will NOT receive the free university credit at Southern Utah University for the work that I do at Southwest Technical College, and that Southwest Technical College will NOT share my educational records with Southern Utah University for this purpose.

I understand the above statements and agree Must accept to proceed

Please review all information above and make sure the information you entered is correct before submitting.

I have reviewed my information and confirm that it is correct Must accept to proceed

Security Check

Required

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Program

Personal Information

Contact Information

Demographic Information

Additional Information

Finish Application