West Kentucky College Academy
Fill out the form below to submit an application for the West Kentucky College Academy The fields required are denoted by an asterisk (*).  NOTE:  You will not be officially enrolled until you receive a copy of your schedule. 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.
*Today's Date -- format mm/dd/yyyy   

*Phone Number --  format xxx-xxx-xxxx      

*First Name

*KCTCS Student ID#

Middle Initial             
*Home High School  
*Last Name             
College of Choice
Date of Birth -- format mm/dd/yyyy 


*Email Address

*Graduation Date  
*Confirm Email Address (enter email address again)

*Select a Program Plan  
*Parent/Guardian's First Name

*Parent/Guardian's Middle Initial

*Parent's Last Name

List the college course(s) you want to enroll in for the current semester in the box below.  Six hours per semester are calculated at the discounted tuition rate. Full tuition wlil be charged for college credit hours above six, per 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