Manual Create an Account Please do not use this form for name changes. All name and information changes require documentation. Please complete the Student Record Change Form. * - denotes a required field. *Last Name *First Name Middle Name Former Last Name Social Security Number *Street Address *City *State *Zip Code *County *Email Address Primary Phone Number Phone Type Make a Selection Home Cell Work Phone Number *Gender Make a Selection Male Female Client Refused *Birth Date Month Month January February March April May June July August September October November December Day Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year Ethnicity Make a Selection American Indian or Alaskan Native Asian Cambodian Laotian Vietnamese Black Hispanic White, not of Hispanic Origin Native Hawaiian or other Pacific Islander Client Refused Secondary Education Make a Selection High School GED HSED Home School EHSED Out of country Highest Grade Completed Make a Selection 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17=greater than 16th No equivalent grade available Client Refused High School Attended High School City High School State Did You Graduate from High School? Make a Selection Yes No Year Graduated from High School? Please allow 24 business hours (Monday-Friday) for processing, before logging in to your WCTC account. Accounts are not processed on Saturday or Sunday. There may be a delay during peak periods.