ale Technical
Dear Candidate and Counselors,
Welcome to Zale Technical! Thank you for your interest in our programs. Our Programs are open to as many individuals, learning styles, and educational backgrounds as possible. It is our hope that you will apply and qualify for one or more of our Programs. To begin and complete this process you will need to:

Read the following instructions completely (Spanish language version available)

Complete the attached application (Spanish language version available)

Submit the requested documentation with your application to Zale Technical.
Please complete the application as accurately and completely as possible. Incomplete applications may be returned or rejected. We recommend that you consult with your advisors and/or counselors that may be assigned to assist you. If you have any questions, you or your counselors are welcome to contact us. Our contact information is at the bottom of page 3 of this Application.
We conduct Orientation sessions most Fridays at 10 am, except for holidays and during quarter breaks.
Orientations are held at:
994 Industry Drive
Tukwila, WA 98188
While we do not require candidates or their counselors to attend an orientation session in order to apply, we do encourage prospective candidates to attend an orientation session as it is a good opportunity to learn more and ask questions about the school, programs, eligibility requirements, electives and other options.
On the Application Form, Zale need to collect the following information:

Grade level placement: Please submit at least one of the following documents: o GED or HS Diploma o Standardized vocational assessments that provide grade level information in Reading,

Language, and Math
For ESL Learners, Zale needs both of the following two pieces of documentation: o ESL placement as determined by CASAS or Current ESL class placement report. o Grade Level Placement Assessment done in the Candidate’s native language.
Please complete the attached application form and submit it to Zale along with Grade Level Placement documents and ESL Level Placement documentation. If any of this information is unavailable, please indicate so on the attached application. We will review your application and may need the candidate to complete additional testing and/or come in for a Candidate Interview. If that is required, we will followup to schedule time to complete these steps.
Sincerely,
Executive Director
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ale Technical
___________________________
Phone Number: ____________________________
Vocational Counselor: ____________________________
(If any – if none, write “none”)
_________________________
e-mail: _______________________ e-mail: _______________________
Phone Number: ____________________________
Legal Representative: ___________________________
(If any – if none, write “none”)
Phone Number: ___________________________
(Select one or more): e-mail: ______________________
Computer System
Certificates
☐ Computer tech
Technology Program:
Business Program: ☐ Customer Service
☐ Parking Attendant
Diplomas
☐ CST – Network, Security, or Program.
☐ CST – Electronic Hardware
☐ Business Office
(Please allow at least 60 days between date of application and requested start date. If additional placement test are requested or required, please allow 90 days)
☐ Winter quarter (Starts 1st week in January)
☐ Spring Quarter (First Monday in April)
☐ As Soon as Possible
☐ Summer Quarter (2 nd Monday in July)
☐ Fall Quarter (4 th Monday in September)
Does the Candidate have a High School Diploma or GED?:
Is the Candidate an L&I Client?
If yes, currently within 24 month retraining period
Yes: ☐
Yes: ☐
Yes: ☐
No:
No:
No:
☐
☐
☐
If within L&I 24 month retraining period, please provide the date L&I training must be completed by: ________________________________
Yes: ☐ No: ☐ Does the Candidate have any physical restrictions?
If yes, please list restrictions on the attached Referral Form
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ale Technical
For Items 4 and 5, please check the appropriate boxes below and submit documentation requested that supports the Candidate Grade Placement Level (and ESL level placement information - if needed):
(Select one)
Documentation Attached ☐ HS Diploma or GED
☐ Vocational Assessment(s) and/or Report(s)
☐ Request Placement Testing
If Requesting Placement Testing, please complete Page 5 of this Application and attached a completed
Referral Form with Referral ID or self-insurer Payer approval.
(select one)
Attached supporting documentation ☐ Not applicable, English is Native Language
☐ CASAS (or other ESL testing scores)
☐ Current ESL Class Placement Level
☐ Unknown – Requesting Testing (Compete page 5)
(select one)
Candidate has been taking ESL Classes ☐ not currently enrolled in ESL classes
☐ Less than 60 days
☐ 2 to 6 months
☐ 7 to 18 months
☐ Over 18 months
Signature of Candidate:
Signature of VRC (if L&I Client):
____________________________________________
____________________________________________
Signature of Attorney (if L&I Client): ____________________________________________
Submit completed and signed application to:
Zale Technical
14900 Interurban Ave South, Suite 271
Tukwila, WA 98168 e-mail: Zale@ZaleTechnical.Org
Fax: (206) 575-2223
Phone: (206) 556-4090
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ale Technical
Reading
Language
Math
Dexterity - Movement
Dexterity – Manual
Dexterity – Finger
Grade Level Other
Reading
Listening
Speaking
Writing
ESL Level CASAS Scale
Based on the information submitted or provided: Eligible after Additional Testing
☐ Yes, Candidate is eligible
☐ Candidate is eligible after 90 days of enrolling in an approved ESL class.
(For L&I Candidates only – requires submission of approved encumbrance)
☐ Candidate is not accepted
☐ Not enough information submitted to determine eligibility
(Please see Additional Testing Requirement on Page 5 of Application)
Candidate is Eligible for the following Program:
☐
☐
☐
Certificates
Computer System ☐ Computer Tech
Technology Program:
Business Program: ☐ Customer Service
☐ Parking Attendant
Diplomas
☐ CST – Network, Security, or Applications
☐ CST – Electronic Hardware
☐ Business Office (all electives)
If Candidate is eligible, Zale will send a Student Planner.
Zale Technical
___________________________
Executive Director
____________
Date
Page 4 of 7

ale Technical
(Only completed this form if you are requesting additional testing or it has been required by Zale)
Dear Candidate and/or Counselor,
If you are requesting, or Zale has determined after reviewing your application, that additional testing is required, please complete the attached Referral Form and submit to Zale. For L&I Candidates, please be sure to include the 7-digit Referral ID
Additional Testing Documents Required:
☐ For L&I Candidates, your VRC needs to fill out Referral Form*
☐ For Non-L&I Candidates, we will inform the Candidates of the testing needed, testing dates, and any cost for additional testing.
*VRC, please indicate if testing and Evaluation funds are still available, please complete attached referral form with 7-digit. Zale uses a Third Party Contractor to complete some or all of their final placement assessments.
Candidate: _________________________________ __________________
Signed :
Vocational Counselor
__________________________________
Date
__________________
Date
Additional Testing Results and Assessment
Based on attached Placement Assessment Results:
Is Candidate Eligible? ☐ Yes
Zale Technical
☐ No
If Candidate is eligible, Zale will send out a Student Planner
Signed:________________________________ __________________
Date
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ale Technical
Date of Request:
*
Authorization of Evaluation
Previous Testing / Assessments?
Client First & Last Name:
Client Claim Number:
Client Address:
Client Telephone #:
Legal Representative (if any)
name & telephone #:
Employer of Record:
Date Of Birth:
English as Second Language:
Native Language:
Yes Referral ID: ___________ (should be 7 digits)
Authorized Dates of Service : From ___________To____________
Procedure Code: 0390R Vocational Evaluation
No Authorization / Code expired Cap limit reached
Yes When:_____________ Paid Amount:__________ No
Date of Injury: Title & DOT of Job At Time Of Injury
Yes No Interpreter Name & #:
High School Diploma:
GED:
Other Education or Training:
Accepted Conditions:
Other Conditions (including documented learning disabilities):
General Work History:
Requested Tests:
Additional Comments for Test
Administrator:
Referral Name & Provider #:
Referral phone #:
Yes No ______Year
Yes No ______Year
Placement CASAS
Referral Contact info:
Address:
Email:
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ale Technical
1) Login to My Secure L&I
CAC Portal (Claim & Account Center) http://www.lni.wa.gov/ORLI/LoGon.asp
2) Enter claim # and click claim status
3) Click on “what is being covered under this claim”
4) Click on treatment and services - note the most recent authorization is on the last page.
5) Find 0390R code and verify that the dates listed are applicable to the evaluation date.
6) Click Voc Information tab on far left and scroll to bottom of page to find Work Eval Paid to Date in last line
7)
8)
Should claim exceed funding for 0390R due to previous work evaluation completed on claim, it may be necessary to ask for authorization from Claim Manager for 0388R miscellaneous billing to cover specific testing needs (i.e. CASAS ESL placement levels etc.)
If code is not listed you may need to request to the claims manager authorization to load it. PLEASE
ENSURE THE CODE AND SERVICE DATES ARE AUTHORIZED PRIOR TO THE EVALUATION DATE FOR
YOUR CLIENT.
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