SY21-22 Region 14 Applied Technology Center Application
Students interested in enrolling in a Region 14 Applied Technology Center (ATC) career and technical education (CTE) program should complete this form.  Region 14 ATC programs are open to students in grades 10-12 from the ConVal, Conant & Mascenic school districts.  In addition to completing this form, students should also speak with their school counselors to register for program courses for the 2021-2022 school year.  All CTE programs are comprised of a sequence of courses; most programs include the option to earn college credit, an industry recognized credential, or both.  If you have any questions regarding the completion of this form, please contact Jennifer Kiley, CTE director, at jkiley@conval.edu.
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Region 14 Applied Technology Center: Serving the communities of the ConVal, Conant & Mascenic school districts
Student Name (last, first, middle initial) *
Street Address *
Town and Zip Code *
Year of Graduation *
High School Student Attends *
Student Cell Phone *
Home Phone Number *
Student Email Address *
Date of Birth *
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Gender *
Race/Ethnic Origin *
Parent /Guardian Name (last, first) *
Relationship to Student *
Parent/Guardian Phone Number *
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