Continuing Education Application

If you are not taking Workforce and Continuing Education classes , please go back and choose the corresponding application.

1109 West Panola Carthage, Texas 75633

903.693.2038

www.panola.edu

Name Information

First Name

Last Name

Suffix

What is your preferred first name?

Other names or aliases which may appear on academic records (Maiden/Birth Name): 

Gender

Birth Date

Social Security Number

You are seeking to participate in Workforce and Continuing Education classes?

Citizenship Information

Birth Country

Citizen Status

Race Information

Race (Choose one or more)

Ethnicity

Military Information

Are you a veteran?

(if requesting benefits, you must submit a military transcript)

Are you a veteran's spouse or dependent?

Contact Information

Do you reside outside of the United States?

Address Line 1

Address Line 2

Zip Code

City

State

County

If Panola County, have you lived here for the last 12 months?

Country

Is your Mailing Address different from your Permanent Address?

Mailing Address:

Address Line 1

Address Line 2

City

State

Zip Code

Mobile Phone Number

Do you agree to receive text messages from college faculty or staff regarding your student account?  

Email Address

Confirm Email Address

Texas Residency

Are you a resident of Texas?

If not Texas Resident, which state?

Did you live in Texas for the 36 months leading up to your high school graduation or Texas GED certification?

When you begin your semester at PC, will you have lived in Texas for 12 months?

Were you enrolled in a Texas Public college or university during the previous 12 months?

If yes, were you classified as a Texas resident at that college or university?

At what location do you plan on studying?

What year do you plan to begin your studies?

What term do you plan to begin your studies?

Choose a program of study.

Choose a program of study.

What is your primary reason for attending?

For the following questions, click "Yes" if they apply to you.

Are you an individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground?

Are you in, or have you aged out of, the foster care system?

Is your parent currently on military active duty?

Are you claimed as a dependent or are you eligible to be claimed as a dependent by a parent or court-appointed legal guardian?

Are you either unmarried or divorced with custody of a child under the age of 18 (including if you are currently pregnant)?

Do you have limited English Speaking ability because English is not your native language? 

Do you have a disability that may make you eligible for support services or funding under the Perkins Career and Technical Education Grant?

Have you been gainfully employed full-time in Texas for the past 12 months?

Have you received primary support from a social service agency for the past 12 months?

How did you find out about Panola College?

Acknowledgement 

I certify that the information provided is accurate to the best of my knowledge. I understand this information will be used by the officials of Panola College in creating state reports and determining residency. I also understand that signing this application confirms that I am familiar with the information provided about Bacterial Meningitis.

I certify that the information in this application for admission is true and correct and that misrepresentation or omission of information will be cause for dismissal or denial of admission. If accepted as a Panola College student, I agree to abide by the rules and regulations of Panola College regarding conduct and all other obligations. I also authorize Panola College to electronically access test scores (TSI or alternates/GED) from any institution or corporate entity which is associated with the transmission of the requested information. I hereby knowingly, freely, and voluntarily waive any right or cause of action arising as a result of the transmission of this information from which any liability may or could accrue to these stated organizations. I understand that Panola College will upon request, provide me with a copy of any of the above documents and I further understand that I have the right to challenge the accuracy of those records.

Digital Signature