MANUAL CAREER TECHNICAL CENTER
2015-2016 ENROLLMENT FORM
(Please Print Clearly)
Name
Last
First
Student I.D. Number
Middle
Address ____________________________________________________________________________
Street Number & Name
Zip Code
Home Phone: __________________________________
Cell Phone or other: ________________
High School
Gender (X) ______ Female ______Male
Grade Level (2015-2016) 11 12 Year of Graduation
Birth Date
Month/Day/Year
Counselor’s Name
in the box of your program of choice.
First Program Choice
c
Second Program Choice
Auto Collision
Auto Technology
Culinary Arts
Construction
Health Science (CNA + Pharmacy Tech)
Auto Collision
Auto Technology
Culinary Arts
Construction
Health Science (CNA + Pharmacy Tech)
ITC-Intro Comp Sci-Game Dsg/CompSci & Software Eng.
ITC- Intro to Eng. Design/Principles of Eng.
ITC-Intro Comp Sci-Game Dsg/CompSci & Software Eng.
ITC- Intro to Eng. Design/Principles of Eng.
My signature below indicates that I am committed to complete the full year program.
Student’s Signature
Date
Date
Parent / Guardian Signature
_____________________________________________________________________
____ A.M. Session
District Personnel Only
GPA__________
Attendance______________
____ P.M. Session
_______ SPED
Credits_________
(yes / no)
I recommend the above student for enrollment in the Career & Technical Education (CTE) program.
Signature (High School Counselor)
Recommended CTE Program
Date
If not recommended, please list reason(s)
Exceptional Education
Manual CTC Use Only:
Received
Case Manager’s Signature
Date
Current IEP is attached, including accommodations.
Request a conference with: __________________________________
SPED:_______________
_________
Date
Student accepted on trial basis ___________
Entered: ___________________
Revised: 08/05/2015
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MANUAL CAREER TECHNICAL CENTER
2015-2016 ENROLLMENT FORM
(Please Print Clearly)
CTE Programs Enrollment Survey:
1. How did you hear about the CTE programs at Manual CTC?
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2. Write a brief essay on why you desire to be in the________________Program at Manual CTC:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
3. What do you hope to gain from your experience at Manual CTC?
_______________________________________________________________________________________________________
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Revised: 08/05/2015
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