Please submit information below. An * denotes a required field.  If you have any questions, please contact the Admissions and Records Office at 855-469-5282. 

Note:  Please allow 5 days for completion of verifications and waiver posts.  You may check your Student Self Service to see if your waiver has been applied.

*First Name

*Phone Number (format xxx-xxx-xxxx)

*Last Name

*KCTCS Student ID# (9 digits)

*Items Needed (Check all that apply)

*Email Address (KCTCS email preferred)

By submitting this form I understand that if my application for a waiver is deemed ineligible or discontinued by the state and/or West Kentucky Community & Technical College, I will be held responsible for all account charges. I also understand that it is my responsibility to notify the waiver coordinator of my enrollment by the first Friday after my classes begin and if I decide to drop or add classes after my waiver has been applied.
Enter 2-character initials