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Special Population Survey

REQUIRED TO BE COMPLETED BY ALL NEW CREDIT STUDENTS

In order to best serve the needs of each of our students, West Georgia Technical College would like to know if you meet any of the criteria listed in the definitions below. Please check each of the following statements that apply to you. You may check as many as are appropriate. Should you choose not to disclose this information you may do so by checking the appropriate option below. Please note that while this information is gathered to better serve your individual needs, it is also used for educational federal reporting purposes.

Please provide your name, SSN or Student I.D. number and check those sections that apply to you.

NOTE: All fields marked with an asterisk (*) must be filled in or the form will NOT submit.

    Special Population Survey

    REQUIRED TO BE COMPLETED BY ALL NEW CREDIT STUDENTS
  • Click to Answer Yes on All of the Below Questions That Apply:

  • Should be Empty:

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