Application2

PERSONAL INFORMATION

(Please use your full legal name)

First Name *

Middle Name

Last Name *

Other Last or Maiden Name

Nickname or Preferred Name:

Social Security Number (No Dashes) *

Date of Birth (mm/dd/yyyy) *

Current Mailing Address *

City *

State *

Zip Code *

County *

Do you have a permanent address different from your current mailing address? *

Yes

No

Permanent Address (if different from current)

City

State

Zip Code

Cell Phone Number (MUST include dashes) * 🛈

Cell Phone Provider *

Text *

Yes

No

Home Phone Number (if applicable) (include dashes)

Email Address *

Confirm Email Address *

Salina Tech utilizes email as its primary method of communication. Please use an email that you will check frequently (do NOT use your high school email as they will bounce back)