TDCJ/TVCC Cont Ed. Application

TVCC/TDCJ Training Partnership

Continuing Education Application
Personal Data

All documents submitted to Trinity Valley Community College to meet admission and residency requirements become part of the official files and cannot be returned.
Are you a TDCJ New Hire? *

Yes No
Which best describes your position at TDCJ? *

Correctional Officer Staff/Administration/Leadership
Name: *

First Name Middle Name Last Name Suffix
Payee ID: *
Are you a US Citizen or Permanent Resident? *

Yes No
Social Security Number or Permanent Residency Number: *
ITIN Number (ITIN number should be provided in lieu of social security number if applicable) :
Country of Citizenship:
Birth Date: *

Month Day Year
Date
Work or Personal Email Address: *
Cell Phone Number: *
Please enter a valid phone number.
Mailing Address: *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
This information is used for statistical purposes only and to provide information required by the Federal Government. You are not required to answer these questions to gain admission; however, an answer would be appreciated.
Gender:

Male Female
Are you Hispanic or Latino?

Yes, I am Hispanic or Latino No, I am not Hispanic or Latino
Please select the racial category or categories with which you most closely identify? Select one or more.

American Indian/Alaskan Native Asian Black or African American Native Hawaiian or Other Pacific Islander White
Residency
Select one: *

I currently live in the State of Texas. I currently live in the United States but not in Texas.
Signature *

Clear
All future TVCC correspondence will be to your Cardinal email account. Please check the email you provided above within 48 hours after submitting your application for instructions on how to login to your Cardinal email account.
Applications submitted without full social security number/permanent residency number and payee ID will not be processed.
Trinity Valley Community College is an affirmative action/equal opportunity institution which provides educational and employment opportunities on the basis of merit and without discrimination or harassment because of race, color, religion, sex, national origin or disability.
Should be Empty:

TVCC/TDCJ Training Partnership

Personal Data

This information is used for statistical purposes only and to provide information required by the Federal Government. You are not required to answer these questions to gain admission; however, an answer would be appreciated.

Residency

All future TVCC correspondence will be to your Cardinal email account. Please check the email you provided above within 48 hours after submitting your application for instructions on how to login to your Cardinal email account.

Applications submitted without full social security number/permanent residency number and payee ID will not be processed.