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Work-Based Learning Student Application for 2022-23
LISD TECH Center
1372 N. Main Street
Adrian, MI 49221
517-265-1659
www.lisd.us/lisd-tech-center
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Street Address
*
Your answer
City
*
Your answer
State
*
Choose
MI
OH
Zip Code
*
Your answer
School Attending
*
Choose
Addison High School
Adrian High School
Blissfield High School
Britton Deerfield High School
Clinton High School
Home School
Hudson High School
Hudson Alternative
Lenawee Christian
JC/LISD Academy
Madison High School
Morenci High School
Morenci Alternative
Onsted High School
Other
Sand Creek High School
Tecumseh High School
Waldron
Tecumseh Virtual
Current Grade
*
Choose
12
11
10
9
8
Student Home Phone
Your answer
Student Cell Phone
Your answer
Student E-mail Address
Your answer
Name(s) of Parent/Guardian Student Lives With
*
Your answer
Parent/Guardian E-mail Address
Your answer
First Choice
*
Choose
Work-Based Learning - Custom Class, Co-Op, Work Experience
Preferred Session
*
Choose
AM session
PM session
Either session
I have discussed my decision to enroll in a program at the LISD TECH Center with my parent/guardian.
*
Choose
Yes
No
I have discussed my decision to enroll in a program at the LISD TECH Center with my high school counselor.
*
Choose
Yes
No
Work-Based Learning (earn high school credit while working)
If you selected Work-Based Learning as one of your choices, please answer the questions below.
I have made contact with an employer
*
Yes
No
Required
Business Name (If made contact with employer, please fill out)
*
Your answer
Supervisor Name
*
Your answer
Supervisor Phone Number
*
Your answer
Employment interest (type of work)
*
Your answer
I am currently enrolled in OR have successfully completed an LISD TECH Center program, and I am interested in a paid Co-op opportunity.
*
Yes (If yes, please enter program below)
No
Required
LISD TECH Center Program
*
Your answer
Work-Based Learning Placements are not guaranteed. If I do NOT get a placement:
*
I am interested in enrolling in my LISD TECH Center class choice
I want to stay at my local district
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