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Admission Application
Portage Lakes Career Center Application for Admission

Student Information


LEGAL NAME
Last Name First Name Middle Name
Invalid Input Invalid Input Invalid Input

City/State of Birth Date of Birth (mm/dd/yyyy) Gender
Invalid Input Invalid Input Invalid Input

Address
Street City Zip Code
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Parent/Guardian
Contact Info
Home/Cell Phone eMail Address (*)
Invalid Input Invalid Input

Residence
School Currently Attending Current Grade (*)
Invalid Input Invalid Input

Ethnic Origin (State Requirement): Please choose all that apply
Invalid Input

Program Choice

(6 Core credits minimum required): Place a "1" beside your first choice. If you are not admitted to your first choice and desire to accepted into another program, place a "2" beside your second choice and a "3" by your third choice.

Arts & Communication
Visual Design & Imaging Invalid Input

Business & Management
Network Computer Technology Invalid Input
Programming & Software Development Invalid Input

Health Services
Athletic Health Care & Sports Science* Invalid Input
Health Care Academy (Pre-Nursing or Medical Assisting) Invalid Input

Human Services
Cosmetology Invalid Input
Culinary Arts Invalid Input
Public Safety Invalid Input

*Class located at Coventry High School

I plan to attend PLCC Invalid Input

 Industrial & Engineering Systems
Automotive Technology Invalid Input
Building Trades Invalid Input
Facility Operations & Maintenance (Counselor Recommended) Invalid Input
Engineering Technology Invalid Input
Electrical Technology Invalid Input
Heating, Ventilation, & Air Conditioning Invalid Input
Welding Invalid Input

Environmental & Agriculture
Plant, Landscape & Turf Management Invalid Input

Co-Op Programs
Cooperative Business Education Invalid Input
Marketing & Management Invalid Input

Parent/Guardian Information

Relationship

Example: Father / Mother / Grandparent / Aunt / Uncle / Guardian / Foster Parent
Invalid Input		 Relationship

Example: Father / Mother / Grandparent / Aunt / Uncle / Guardian / Foster Parent
Invalid Input
Name

Invalid Input		 Name

Invalid Input
Home Phone

Invalid Input		 Home Phone

Invalid Input
Cell Phone

Invalid Input		 Cell Phone

Invalid Input
Email Address

Invalid Input		 Email Address

Invalid Input
Home Address (if different from student)

Invalid Input		 Home Address (if different from student)

Invalid Input
Does student live with this parent?

Invalid Input		 Does student live with this parent?

Invalid Input
If No, is there Parental Joint Custody?

Invalid Input		 If No, is there Parental Joint Custody?

Invalid Input

Partner/Home School: Please choose one






Invalid InputPlease list other here:

Are you open-enrolled into this district? Invalid Input
If Yes, what is your resident district? Invalid Input

IMPORTANT

Parent/Guardian & Student: Read Carefully!

required Fees - The Career Center will provide most equipment and materials used for daily instruction; however, students may be asked to pay a fee if large amounts of materials or personal tools are required. Students will also be expected to purchase uniforms and/or books if required by the academic and/or technical program. Information concerning financial assistance or individual payment plans can be obtained by calling the treasurer's office. FEES MUST BE PAID BEFORE GRADES OR CREDIT WILL BE RELEASED.

Required Release & Consent - I give permission to release photos, video footage, or electronic images in any way appropriate to promote the school and its programs without exceptions, now and in the future unless a parent, guardian, or adult student notifies the Community Relations Office in writing that he/she will not permit distribution of any or all such information.

required Agreement for use of Computer Equipment & Internet - Use of district computers and networks, including Internet access, is limited to educational purposes. The smooth and efficient operation of network resources relies upon the proper conduct of end users who must adhere to strict guidelines. Failure to comply with these guidelines will result in the termination of his/her access and future access could be denied. Agreement with this policy is valid for your tenure at the career center. The complete Acceptable Use Policy is available on the distrct website at www.plcc.edu or by request.

Admissions & Record Release Consent

requiredParent/Guardian: I give permission for my son/daughter to enroll at Portage Lakes Career Center and for the release of all school records, test scores and information to Portage Lakes Career Center.

requiredStudent: I have carefully considered my program choice and wish to be considered for admission to Portage Lakes Career Center. I give permission for the release of all school records and information to Portage Lakes Career Center.

I HAVE READ AND UNDERSTAND THE ABOVE
Please select both options to agree.
 required required



The Portage Lakes Joint Vocational School District is an equal opportunity educational institution. Employment and educational programs are offered without regard to race, color, religion, national origin, gender, disability, military status, ancestry or age. The district prohibits harassment of individuals in any form. Concerns of possible discrimination or harassment should be referred to Mrs. Elizabeth P. Prince, Compliance Coordinator, at 330-896-8200.

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