College of Nursing & Health Sciences (Admitted Students Only) Titan VIP Experience Visit Now – College of Nursing & Health Sciences Please complete and submit at least four weeks or 30 days before your desired visit date.*Complete the form. We will contact you to schedule your visit.Approval is not guaranteed; however, more advanced notice may increase the likelihood of accommodation. *All VIP Experiences begin at 9:00 a.m. UntitledFirst ChoiceSecond ChoiceThird ChoiceNumber of Guests (Admitted Student and up to Two (2) Guests):*012Student Name* First Last Student Email* Enter Student Email Confirm Student Email Email of Parent/Guardian: Anticipated College Entry Term:*Spring 2021Summer 2021Fall 2021Spring 2022Summer 2022Fall 2022Spring 2023Summer 2023Fall 2023Applicant Type:*First-Year/FreshmanTransferReadmitted/Former CCTC StudentSpecial/VisitingStudent Phone*Student Cell Phone*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Will you be a first-generation college student?YesNoIf neither of your parents graduated from college, choose yes. U.S. Armed Forces Status (if applicable):Not ApplicableCurrently ServingVeteranCurrent DependentCurrent or Last School Attended*Primary Academic Interest of the Group: (Link to Programs of Study)*UndecidedNursing (ADN) (NURS) (Associate Degree)Nursing (LPN to ADN Option) (Associate Degree)Massage Therapy (Certificate)Medical Assisting (Diploma)Medical Record Coding (Certificate)Pharmacy Technician (Certificate)Physical Therapist Assistant (AA/AS)Surgical Technology (Diploma)Patient Care Technician (Certificate)Secondary Academic Interest of the Group: (Link to Programs of Study)UndecidedNursing (ADN) (NURS) (Associate Degree)Nursing (LPN to ADN Option) (Associate Degree)Massage Therapy (Certificate)Medical Assisting (Diploma)Medical Record Coding (Certificate)Pharmacy Technician (Certificate)Physical Therapist Assistant (AA/AS)Surgical Technology (Diploma)Patient Care Technician (Certificate)What is your long-term educational goal after graduating from Central Carolina Technical College?Special Dietary Needs: No Yes Please specify:Special Accommodations:NoYesPlease specify: