To enroll in dual credit courses at WKCTC, you must fill out the form below.

Fill out the form below. You must return the student authorization form  with all signatures to Lorry Beth Wilson, Director of West Kentucky College Academy, 270-534-3117 or lorrybeth.wilson@kctcs.edu.

*KCTCS Student ID#

*Home High School  
*Counselor's Name             
        
*Last Name             
        
*First Name

Middle Initial             

*Mailing Street / PO Box Address             
        
*City, State, Zip             
        
*Graduation Year    
*Email Address

*Student Phone #:  format xxx-xxx-xxxx      

 
*Birth Date (mm/dd/yyyy) 

*Parent/Guardian's Name

*Parent's E-mail:

*Parent Phone #:  format xxx-xxx-xxxx      

 
Why are you taking this course?


What career do you plan to pursue?


College of Choice
Please list courses that you plan to enroll in for current semester.       


By completing this form and providing my initials, I wish to be enrolled in the courses that I have listed, for the current semester. I authorize the parent/guardian indicated above as well as my high school administrators, counselors, and faculty access to indicated information on my account.  Within ten days of completing this application, I will print the FERPA form (click here to print ) and have it completed, signed, and returned to the address listed on the form.      
*
Enter 2-character initials