Lewis & Clark Career Center Application

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LEWIS & CLARK CAREER CENTER PROGRAMS ARE OFFERED WITHOUT REGARD TO RACE, NATIONAL ORIGIN, SEXUAL ORIENTATION, GENDER OR DISABILITY. LEWIS & CLARK CAREER CENTER IS ONLY FOR HIGH SCHOOL STUDENTS THAT LIVE IN ST CHARLES COUNTY MISSOURI.

Student Last Name *

Student First Name *

Student date of birth *

YYYY

Student T-shirt size *

Student email *

Address *

City *

State *

Zip *

Student Cell Number *

Parent/Guardian Names *

Parent Cell Number *

Parent Email *

Alt. Parent Cell Number

Alt. Parent Email

School District *

Current High School *

Current grade in school *

9th

10th

11th

12th

Do you require small group testing? *

Yes

Please select your first choice program ( pick 1) *

Please explain why you selected this as your first choice:

Please select your second choice program (pick 1) *

Please explain why you selected this as your second choice:

Please select your third choice program (pick 1)

Please explain why you selected this as your third choice:

Have you visited Lewis and Clark campus?

Yes

Clear selection

How did you hear about Lewis & Clark?

List any family members who attended L & C:

I am seeking application for Lewis & Clark Career Center. I have discussed my intent with my parents/guardians. By submitting this application I grant my high school permission to issue L & C my records including transcript, attendance, discipline, etc. for evaluation.

Checking this box states I have read and agree with the above statement.

Submit

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