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Tarkio Technology Institute Application

Application

First Name:

Middle Name:

Last Name

Last Four Numbers of SSN

Select Course

Continuing Ed

Select Semester

Email: (Please do not use your high school email)

How did you hear about Tarkio Tech?

Phone:

Permission to text you?

Address Line 1

Address Line 2

City

State

Zip Code

Do you hold Citizenship outside of the US?

Birthdate

Gender

Ethnicity

High School Last Attended

School Contact Name

School Contact Information Phone/Mobile

Permission for the school to access previous school records

Name of Emergency Contact

Emergency Contact Address Line 1

Emergency Contact Address Line 2

Emergency Contact Cell Phone Number

Emergency Contact Home Phone Number

City

State

Zip Code

Country

Relationship

Electronic Signature

Classes

Business Hours

Mon - Fri: 8:00 am - 5:00 pm
Sat - Sun: Closed

Address