UPDATED 2014 2015 Academy Application JAN 2015 Essays

Submitted By FRANCISCA-MARTINEZ-D
Words: 541
Pages: 3

Please print. Illegible handwriting may result in delayed enrollment.

Part 1: Student Information

Student LEGAL Name ____________________________________________________ Graduation Year________________ FIRST MI LAST

Birth Date___/___/___ Gender: _____________

Student Email: ____________________________________________Student Cell Number: _______________________

Student Ethnicity:

____American Indian (Tribe) ___________
____Asian
____Black
____ White
____Pacific Islander
____Hispanic

Student Lives With:
__Father
__ Mother
__Both
__ Guardian ____________
__On Own__ Address: _______________________________

Student’s Birth Place (City, State or Country) ______________________________________

Student’s Primary Language ___________________________ Student’s Home Language _____________________________
Is there anything you would like us to know about you, your learning style, or any other important information?

________________________________________________________________________________________________________

Part 2: Parent/Guardian and Emergency Information
Contact 1:
Parent ___ Guardian___
________________________________________________
Last First Relationship to student: ____________________________ Address _________________________________________
City________________________ Zip Code__________
Home Phone: ______________ Cell: ________________
Email ___________________________________________
Contact 2:
Parent ___ Guardian___
________________________________________________
Last First Relationship to student: ____________________________ Address _________________________________________
City________________________ Zip Code__________
Home Phone: ______________ Cell: ________________
Email ___________________________________________
Emergency Contact Not living with Student Name ________________________________________ Relationship ________________ Phone ______________

I authorize the Northwest Career & Technical Academy to: Have access to any and all of my student’s school records; to use my student’s Social Security number for the purposes of processing and identifying records routinely associated in all reports at local, state levels, and post-graduation information; to obtain my student’s photo and/or statements as they relate to the mission of the Academy, and/or to aid in the success and promotion of career & technical education. The signature of students over the age of 18 living independently verifies agreement. I also understand that if my student participates in an off-campus program, location, or clinical, I will be required to provide transportation.

Parent/Guardian Signature______________________________________________________Date_______________

Part 3: Academy Program Selection

Unless noted in the Session 3 offerings all classes run Monday through Friday. The Academy follows the Mount Vernon School District Calendar for breaks and most half days.

Mount Vernon Main Campus 2205 West Campus Place Mount Vernon, WA 98273

Anacortes Campus 1606 R Avenue Anacortes, WA 98221

Whatcom County Campus @ Meridian High School 194 West Laurel Road Bellingham WA 98226…