HS_app-2012

How do you plan to use the training you receive at Central Tech?

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What makes you a good candidate for the program? (Experiences, classes taken, career goals, etc.)

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My career interests include:

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Please list any clubs, organizations or community activities in which you participate:

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Choose the statement that best describes how you feel about your program choice.

_____ a. I have had an interest in this career fi eld for a long time.

_____ b. I recently became interested in this career fi eld, and I’d like to learn more.

_____ c. Other _____________________________________________________

Bottom section to be completed by interviewer. Interview Date: _____________

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BEFORE THE INTERVIEWPlease respond to the following questions in your own handwriting using complete sentences.

Be prepared to discuss your responses with a Central Tech representative.

Application will not be considered for acceptance until all signatures are provided.

Central Technology Center, in compliance with Title VI of the Civil Rights Act of 1964, Title VII and Title IX of the Education Amendments of 1974, Section 504 of the Rehabilitation Act and the Americans with Disabilities Act (ADA), does not discriminate on the basis of race, color, religious creed, national origin, age, sex/gender, disability or veteran status in any of its policies, practices or procedures. These equal opportunity provisions include, but are not limited to, admissions, employment, fi nancial aid and educational services. For detailed information on Central Tech’s gainful employment, please visit any full-time class on our website at www.centraltech.edu

Checklist (Offi ce Use Only)

___ PLAN Score (Composite) ___ Cumulative GPA ___ High School Transcript ___ Attendance Report

___ Other _________________

Instructional Area

High School Application for Admission2012-2013

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Name Social Security Number (optional)

Birthdate E-mail Address

Circle the grade you will be in during the 2012-2013 school year: 10 11 12

Home Mailing Address City Zip

Home Phone Number Cell Number

My Top 3 Choices for Central Tech (in order) are: (Pick from the class choices bulleted on the adjacent page.)

1. 2. 3.

Class Preference - Circle one AM PM Either

Have you previously attended Central Tech? Yes No If so, what program?

Circle how you learned about Central Tech? Friend Brochure Counselor Newspaper CT Showcase Open House Other

Parent(s)/Guardian(s) Names

Father’s place of employment Work Phone Cell

Mother’s place of employment Work Phone Cell

Parent(s) E-mail address

Date High School Attending

Signature of applicant

PARENT RELEASE APPROVAL• This is an authorization for the local school district to release to Central Tech the student records, including confi dential records, concerning my son/daughter as they relate to determining appropriate enrollment at Central Tech.• I hereby give approval to have my son/daughter attend the class for which he/she may be approved.

Signature of parent /guardian

High School Application for Admission2012-2013

Agriculture, Food & Natural Resources • Service Careers

Architecture & Construction • Design Drafting • Construction Trades • Electrical Trades

Arts, Audio Video Technology & Communications • Digital Printing & Imaging Communications • Graphic Design • Interactive Multimedia

Business, Management & Administration • Administrative Assistant Medical • Business and Information Technology

Health Science • Biomedical Sciences • Health Careers Certifi cations • Medical Assisting Human Services • Cosmetology Information Technology • Interactive Multimedia • Network Security and Administration

Law, Public Safety, Corrections & Security • Criminal Justice

Manufacturing • Design Drafting • Mechatronics Technology • Welding/Fabrication Technology Science, Technology, Engineering & Mathematics • Biomedical Sciences • Design Drafting • Pre-Engineering Academy • Oklahoma School of Science and Math

Transportation, Distribution & Logistics • Automotive Service Technology • Diesel Technology • Power Sports Technology

• = Drumright campus only

• = Sapulpa campus only

• = Both campuses

Enrollment Questions? Call us.

Drumright Campus Chet Cundiff

918.352.25513 CT Circle, Drumright, OK 74030

Sapulpa Campus Linda Enlow

918.224.93001720 S Main, Sapulpa, OK 74066

www.centraltech.edu

Application will not be considered for acceptance until all signatures are provided.

College credit for many technology courses is available for high school students. College credit is made possible through an Alliance Agreement. High school students who meet the admission criteria set forth by the alliance may enroll in college technology courses, and grades for those courses will be transcripted at the college upon course completion. Earn 1-48 hours of college credit for $8 per college hour dependent upon course enrollment.

Admission Criteria for College Credit• Minimum 2.5 GPA or• Minimum ACT Score of 19 or• Minimum PLAN Score of 15

Apply now, and let Central Tech

make a difference in your life.