SAN JUAN COLLEGE

TTEN APPLICATION

NAME OF CANDIDATE ___________________________________

PARENT'S NAMES ______________________________________

ADDRESS _____________________________________________

SSN# ___________ DO YOU HAVE A VALID DRIVER'S LICENSE? ___YES ___NO

DRIVER'S LICENSE NUMBER ____________STATE____________

HAS YOUR LICENSE EVER BEEN REVOKED? (IF YES, EXPLAIN).

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HOME PHONE NUMBER ( ) _________ MESSAGE NUMBER ( ) ____________

EDUCATIONAL BACKGROUND

Last High School Attended _______________________________________

Graduation Year ________ Location _______________________________

Did you participate in a high school automotive program? _______________

If you have attended college before, please attach a copy of your transcript (an unofficial copy will be accepted).

Other educational experience and training (military schools, seminars etc....)

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Work experience (most recent first)

COMPANY TITLE/DUTIES DATES

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Career objectives/goals (write a clear statement of your career objectives/goals.)

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___________________________________________________________________________

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I hereby certify that the foregoing statements are true and correct. I understand that if I have knowingly provided incorrect or false information, I may be denied the opportunity to participate in the Toyota TTEN program.

Release of Information

I have applied for the Toyota-San Juan College Automotive (TTEN) program, and authorize the officials of San Juan College to transmit any placement test scores, college transcripts, and/or other academic and dealership registration information to the Toyota officials involved with the TTEN program.

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Student's Signature Date

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SAN JUAN COLLEGE, TECHNOLOGY DIVISION

4601 COLLEGE BLVD.

FARMINGTON, NM 87402