West Central Indiana CTE 2022-2023 Program Enrollment Form

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Students interested in enrolling in a pathway offered by West Central Indiana Career & Technical Education for the 2022-2023 school year must complete ALL sections of this enrollment form.

PLEASE DO NOT EDIT THIS FORM. 1.7.22

First Name *

Last Name *

Student Home High School *

Crawfordsville High School

North Montgomery High School

Southmont High School

Western Boone Jr/Sr High School

Fountain Central High School

North Putnam High School

Desired Pathway for 2022-2023 School Year *

Automotive Services Pathway

Business Administration Pathway

Criminal Justice Pathway

Cosmetology Pathway

Information Technology Support & Services (Cybersecurity focus) Pathway

Emergency Medical Technician Pathway

Fire and Rescue Pathway

HVAC Pathway

Pharmacy (online program, requires School Counselor approval)

Pre-Nursing (Certified Nursing Assistant/Capstone) Pathway

Precision Machining Pathway

Radio and Television Pathway

Welding Technology Pathway

Work-Based Learning (must be approved by CTE Director)

Grade for 2022-2023 School Year *

Gender *

Female

Male

Parent/Guardian First Name *

Parent/Guardian Last Name *

Home Mailing Address: Street Address *

Home Mailing Address: City *

Home Mailing Address: State *

Home Mailing Address: Zip Code *

Student Phone

Parent/Guardian Phone *

Student Personal Email (not school email) *

Parent/Guardian Email *

Student Date of Birth *

YYYY

In the space provided, please share a thorough Statement of Interest that expresses why you are enrolling in the program indicated above. Statements of Interest may be shared with Program Instructors and School Counselors to determine admittance to programs where seats are limited. Maximum response length is 500 characters. *

West Central IN CTE offers transportation to and from the following programs: Auto, Business Administration, Criminal Justice, Cybersecurity, EMT, Fire/Rescue, HVAC, Pre-Nursing, Radio/TV, and Welding. If you are applying for one of the programs listed, is transportation something you would need to utilize at any point during the 2022-2023 school year? (If you are applying for Cosmetology, Pharmacy, or Precision Machining, select "No".) *

Yes

Maybe

This form is only to report demographic information required for students enrolled in Indiana Career and Technical Education pathways. West Central IN CTE and participating school corporations provide equal employment and educational opportunities for all individuals, regardless of sex, race, religion, or national origin. rev. Dec2019

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