Student Application Information
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1
2Student Application Information (Please Print)
Name ____________________________________________________________________________
Date of Birth___________________
Last
First
Middle Initial
High School______________________________________________
Current Grade: ______________
Legal Town of Residence_____________________________________
Mailing Address _________________________________________________________________________________________________________________________________
Street (with #)
City
State
Zip
Mailing Address #2 _____________________________________________________________________________________________________________________________
( for mailings to 2 homes)
Street (with#)
City
State
Zip
Student Cell Phone ____________________________________
Student E-mail_______________________________________________
Parent/Guardian Name ____________________________________________ Primary Phone Contact # ___________________________
E-mail ____________________________________
Parent/Guardian Name _____________________________________________Primary Phone Contact # ____________________________
E-mail ____________________________________
Please Indicate the BTC program you are applying to:
For students entering 11th and 12th grades in the 2017-18 school year; please indicate 1st and 2nd choice.
❏ Auto Body Repair
❏ Automotive Science & Technology
❏ Aviation & Aerospace Technology
❏ Computer Systems & Emerging Technologies
❏ Criminal Justice
❏ Culinary Arts
❏ Design & Illustration
❏ Digital Media Lab
❏ Human Services
❏ Medical & Sports Sciences
❏ Programming & Computer Science
❏ Welding/Metal Fabrication
For students entering 9th and 10th grades in the 2017-18 school year:
❏ Pre-Tech Exploratory
Some BTC programs have safety risks due to the nature of the equipment and tools used in those programs. We understand
that care, caution and appropriate behavior are necessary to ensure a safe environment for oneself and others.
________________________________________________________
__________________
____________________________________________
__________________
S tudent Signature
Date
Parent/Guardian Signature
Date
Sending School Personnel: Please sign & include the following with the application: Transcript & Attendance
_______________________________________________________________________
______________________
Counselor, Case Manager or Advisor Signature
Date
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