Please complete the fields below, and hit "submit." Fields marked with an asterisk * are required. Contact Information * First Name * Last Name * Email Address * Confirm Email * Mailing Address * City * State *** Foreign Country *** Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba, Canada Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Ontario, Canada Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming * Zip * Phone * Date of Birth (mm/dd/yyyy) Registration Information * I'd like to visit Southwest Tech on * I plan to become a Southwest Tech student Spring 2018 Fall 2018 Spring 2019 Fall 2019 Unsure * High school graduation year 2022 2021 2020 2019 2018 2017 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 * High school attended Argyle Barneveld Belmont Benton Black Hawk Boscobel Cascade (IA) Cassville Central, Dubuque (IA) Clayton Ridge (IA) Cuba City Darlington Dodgeville Edgewood-Colesburg (IA) Fennimore Highland Ithaca Iowa-Grant Kickapoo Lancaster MFL Marmac (IA) Mineral Point North Crawford Pecatonica Platteville Postville (IA) Potosi Prairie du Chien Richland Center River Ridge River Valley Riverdale Seneca Shullsburg Southwestern Waukon (IA) Wauzeka Steuben Western Dubuque (IA) Weston Other * Name of High School * Which program would be your first choice? * Which program would be your second choice?
