Utility Line Worker Program – CTE Application

Please complete the Utility Line Worker Program application. This program is located on the Olive Branch Campus.

Admissions to the college does not guarantee admissions to the program of study.

Click the link below for additional enrollment qualifications.
Visit the Utility Line Worker Page!

Applicant Information

Student ID Number

First Name *

Middle Name

Last Name *

Birthdate *

Email Address *

Mobile/Cell Phone Number *

Alternate Phone Number

Permanent Address *

Country

Street

City

Region

Postal Code

Enrollment Information

Career-Technical Education Pathway *

Entry/Start Term *

Which Campus do you want to attend? *

Do you plan to be involved in any of the following programs?

Band

Choir

Athletics

None of the above

Application Information

Substance Testing
All potential and current Utility Line Worker Program students must submit to a substance testing in accordance with the substance testing policies and procedures. View the Drug Screen Policy & Test Result Form here.

Are you willing to submit to a drug screening for your admission into the program? *

Yes

No

By selecting “No,” you indicate that you are not willing to submit to a required drug screen. Students who are not willing to complete the drug screen are not eligible for this program.

Why do you want to be in the NWCC Utility Line Worker Program? *

Upon graduation from the Utility Liner Worker Program, do you plan on working in the state of Mississippi? *

Yes

No

If no, please indicate below the state or territory where you plan to seek employment. *

Background Information

Have you had more than 3 tickets in the past 3 years? *

Yes

No

If yes, please explain.*

Have you received any DUIs in the past 5 years? *

Yes

No

If yes, please explain.*

Have you had any serious driving infractions in the past 3 years (such as; reckless driving, careless driving or speeding more than 10 MPH over posted speed limit, etc.)? *

Yes

No

If yes, please explain.*

Have you been convicted of any felonies in the past 5 years? *

Yes

No

If yes, please explain.*

Required Documents

Please submit all required documents listed below by uploading them through this application, scanning and emailing them to ctedocs@northwestms.edu, or delivering them in person to the DeSoto Campus.
All documents must be submitted prior to program acceptance.

Additional documents are required for this application. They will appear on your application checklist status page.

Please submit a copy of your valid driver's license. *

Please complete and upload the Background Inquiry Release. Please click here to fine the Background Inquiry Release Form . *

Application Confirmation

By submitting my full name and date below I confirm that the statements and information furnished in the application are true and complete.

Enter your full name as your digital signature *

Click to Sign...

Today's Date *

Equality Statement

Northwest Mississippi Community College does not discriminate on the basis of race, color, national origin, sex, disability, religion, gender identity, age, or status as a veteran or disabled veteran in all its programs and activities. Northwest Mississippi Community College prohibits sexual harassment and all forms of sexual violence, regardless of sex, gender identity or sexual orientation. The following have been designated to handle inquiries regarding non-discrimination policies:

Americans with Disabilities Act of 1990/Section 504 of the Rehabilitation Act of 1973:
Disability Support Services Coordinator
Tate Hall, P.O. Box 5555
4975 Highway 51 North
Senatobia, MS 38668
Phone: 662-562-3309
Email: mkelsay@northwestms.edu

Title II of the Age Discrimination Act:
Vice President for Finance and Administration
James P. McCormick Administration Building, P.O. Box 7017
4975 Highway 51 North
Senatobia, MS 38668
Phone: 662-562-3216
Email: jhorton@northwestms.edu

Title IX of the Educational Amendments of 1972/Title VII of the Civil Rights Act of 1964:
Vice President for Student Services and Enrollment Management
Tate Hall, P.O. Box 7010
4975 Highway 51 North
Senatobia, MS 38668
Phone: 662-562-3409
Email: trush@northwestms.edu

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Yes

No