Texas Chiropractic College

To speed the admissions process, make sure you answer all applicable questions. All fields in RED are required prior to submitting the application. You may be contacted by the Admissions Department to complete any unanswered questions.

**General Information**
Title:	email:
Last Name:	First Name:	MI
Current Address:
City:	State:
Zip:	Country :
Day Phone:	Evening Phone:


Ethnic Origin:	Date of Birth:
Gender: Male Female	Birthplace: City: State: Country:
The information requested in this section is used purely for statistical purposes as required by the Federal Government. Texas Chiropractic College admits students without regard to race, color, religion, sex, age, national or ethnic origin, handicap or veteran status and entitles all to the rights, privileges, programs and activities generally accorded to its students.

Citizenship, Residency & Language
U.S. Citizen? Yes No	Permanent resident? Yes No
Resident of— City:	— State:	— Country:

Texas Residents
To claim Texas residency you must have resided in the State of Texas for a minimum of twelve (12) months immediately prior to enrolling in a Texas institution of higher education.
Oath of Residency	(For those claiming Texas residency only)
"I affirm that I am a resident of the State of Texas"	Signature:	Date residency began:
Is English your native language?	Yes No	If No, then what is?
If English is not your native language, have you taken the Test of English as a Foreign Language, (TOEFL)?		Yes No
TOEFL Score	Test Date:	Have the scores been sent to TCC? Yes No
All non-US citizens and non-permanent residents are to complete the following:
Country of Citizenship:		Number of years in the US?
Do you currently hold a visa?	Yes No	If yes, what type?

Academic Information List all colleges attended beginning with the highest degree earned. All institutions attended must be listed. Email additional college listings to admissions@txchiro.edu. Failure to complete this section fully and accurately constitutes misrepresentation and may result in dismissal from the college. (Official transcripts must be mailed to Admissions directly* from all colleges or universities.)*
Name of Institution	Start Date	End Date	Degree Earned /Major	Eligible to Re-enroll?
				Yes No