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CTE Student Enrollment Form
2024-2025 School Year
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* Indicates required question
Student Last Name
*
Your answer
Student Middle Name
*
Your answer
Student First Name
*
Your answer
Gender
*
Female
Male
Prefer not to say
Student School Email
*
Your answer
Student Personal Email -
MUST BE DIFFERENT FROM SCHOOL EMAIL
*
Your answer
1st Choice Program
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Choose
Automotive Service Technology
Auto Body Collision Repair
Construction Trades
Cosmetology
Criminal Justice
Culinary Arts
Electrical, Plumbing, and HVAC
Interactive Media
Marine Service Technology
Precision Machining
Primary Health Care (CNA---1st Year Students) - Additional Application and Paperwork Required
Primary Health Care (CMA---2nd Year Students)
Smart Technologies and Automation
Welding
2nd Choice Program
*
Choose
Automotive Service Technology
Auto Body Collision Repair
Construction Trades
Cosmetology
Criminal Justice
Culinary Arts
Electrical, Plumbing, and HVAC
Interactive Media
Marine Service Technology
Precision Machining
Primary Health Care (CNA---1st Year Students) - Additional Application and Paperwork Required
Primary Health Care (CMA---2nd Year Students)
Smart Technologies and Automation
Welding
Not interested in any other program
3rd Choice Program
*
Choose
Automotive Service Technology
Auto Body Collision Repair
Construction Trades
Cosmetology
Criminal Justice
Culinary Arts
Electrical, Plumbing, and HVAC
Interactive Media
Marine Services Technology
Precision Machining
Primary Health Care (CNA---1st Year Students) - Additional Application and Paperwork Required
Primary Health Care (CMA---2nd Year Students)
Smart Technologies and Automation
Welding
Not interested in any other program
High School You Attend
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Choose
Angola
Churubusco
Central Noble
DeKalb
East Noble
Eastside
Fremont
Garrett
Hamilton
Lakeland
Prairie Heights
West Noble
Westview
Grade For 2024-2025 School Year
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Choose
11
12
Year in Program
*
Please mark 1st year in program or 2nd year in program.
Choose
1st year
2nd year
Date of Birth Month
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Choose
January
February
March
April
May
June
July
August
September
October
November
December
Date of Birth Day
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Choose
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Date of Birth Year
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Choose
2005
2006
2007
2008
2009
Home Street Address (NOT EMAIL ADDRESS)
Example: 123 Jones Place
*
Your answer
City, State, Zip
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Choose
Albion, IN 46701
Angola, IN 46703
Auburn, IN 46706
Ashley, IN 46705
Avilla, IN 46710
Brimfield, IN 46720
Butler, IN 46721
Churubusco, IN 46723
Columbia City, IN 46725
Corunna, IN 46730
Cromwell, IN 46732
Fremont, IN 46737
Garrett, IN 46738
Hamilton, IN 46742
Helmer, IN 46744
Howe, IN 46746
Hudson, IN 46747
Kendallville, IN 46755
Kimmel, IN 46760
Ligonier, IN 46767
LaGrange, IN 46761
LaOtto, IN 46763
Middlebury, IN 46540
Orland, IN 46776
Pleasant Lake, IN 46779
Rome City, IN 46784
St. Joe, IN 46785
Spencerville, IN 46788
Stroh, IN 46789
Topeka, IN 46571
Shipshewana, IN 46565
South Milford, IN 46786
Waterloo, IN 46793
Wawaka, IN 46794
Wolcottville, IN 46795
Wolf Lake, IN 46796
Other - My City is Not Listed
Mother/Guardian First Name
*
Your answer
Mother/Guardian Last Name
*
Your answer
Father/Guardian First Name
*
Your answer
Father/Guardian Last Name
*
Your answer
Mother/Guardian Phone Number (123)123-1234
*
Your answer
Father/Guardian Phone Number (123)123-1234
*
Your answer
1st Emergency Contact First Name (other than parent)
*
Your answer
1st Emergency Contact Last Name (other than parent)
*
Your answer
1st Emergency Contact Number (other than parent)
*
Your answer
2nd Emergency Contact First Name (other than parent)
Your answer
2nd Emergency Contact Last Name (other than parent)
Your answer
2nd Emergency Contact Number (other than parent)
Your answer
Parent/Guardian Email Address
*
Your answer
Parent/Guardian Email Address
Your answer
Briefly describe why you want to be accepted into an Impact Institute program.
*
Your answer
List classes you have taken in high school and/or work experience that would relate to the Impact Institute program you are interested in.
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Your answer
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