2019-2020 APPLICATION FOR ADMISSION Last Name First Name (Full name/ No nicknames) MI Home Address City Zip Home Phone Number Date of Birth Gender (Check one) District: Male Female STUDENT CONTACT INFORMATION: TO BE COMPLETED BY PARENT/ GUARDIAN PRIMARY CONTACT: Does the Student Reside with Primary Contact: Yes No Secondary CONTACT: Does the Student Reside with Secondary Contact: Yes No Parent(s) Father Mother Guardian Other Parent(s) Father Mother Guardian Other Title: (Check one) Dr. Mr. Mrs. Miss Ms. Rev. Title: (Check one) Dr. Mr. Mrs. Miss Ms. Rev. Name of Primary Contact: Address : Home Phone Number: ( ) Cell Number ( ) Work Number & Ext ( ) Email: Does the Primary Contact have educational/ correspondence rights? Y N Is the person active duty military member? Y N Name of Primary Contact: Address : Home Phone Number: ( ) Cell Number ( ) Work Number & Ext ( ) Email: Does the Primary Contact have educational/ correspondence rights? Y N Is the person active duty military member? Y N Admissions Agreement To be signed by parent and student. Choosing to attend Schuylkill Technology Center (STC) requires making an informed and responsible career decision. A student s success and continued enrollment will depend on the following: 1. Regular Attendance- You will be required to be prompt and attend regularly as per STC School Attendance policy. 2. Positive Behavior and Self-Discipline- You are required to work cooperatively with all staff and students demonstrating respect and self-control at all times. 3. Effort and Safety- You will be required to participate actively in all educational activities as directed by the teacher, achieve to the best of your ability, and adhere to all safety rules and regulations. Furthermore, you agree not to attempt any procedure, use any tools/ equipment or handle any supply or material without proper training and the approval of the assigned teacher. 4. Financial Requirement- You may be required to purchase certain items that uniquely pertain to your particular program (e.g. personal safety equipment, clothing and/or selected tools). Both the student and the parent agree to the aforementioned requirements and acknowledge the failure to comply may result in the removal from STC. I am committed to admissions agreement and request admissions to STC Student Signature Date I have examined the information on the application & agree with the program selection requested. Parent Signature Date Place a number one(1) in front of your first selection and a number two(2) in front of your second choice: Information Technology Law, Public Safety, & Security Computer Information Systems 52.12101 Criminal Justice 43.0107 Architecture & Construction Manufacturing Carpentry Technology 46.0201 Electromechanical 15.0403 Masonry Technology 46.0101 Precision Machining Technology 48.0501 Plumbing & Heating Technology 46.0503 Welding Technology 48.0508 Residential/Industrial Electricity 46.0399 Health Science Marketing Health Careers 51.0899 Marketing & Business Management 52.1801 Hospitality & Tourism Transportation, Distribution & Logistics Culinary Arts 12.0508 Automotive Technology 47.0604 Human Services Collision Repair Technology 47.0603 Cosmetology 12.0401 Diesel Technology 47.0613 Early Childhood Care & Education 19.0708 Outdoor Power Technology 47.0699
Write a brief paragraph responding to the following questions: 1- What STC program are you most interested in attending? 2- Why are you interested in this program? 3- What experience, if any, do you have in this field? 4- What job do you see yourself doing 5 years from graduation? The Schuylkill Intermediate Unit does not discriminate on the basis of race, color, national origin, sex, disability, or age or Boy Scouts and other youth groups in its career and technical education programs or activities. For information regarding civil rights, grievance procedures, or access, contract the Title IX Coordinator/ Section 504 Coordinator: Dr. Gregory Koons, Executive Director, 17 Maple Avenue, Mar Lin, PA 17954 {Telephone number (570)544-9131 Fax number (570)544-6412}.
For Schuylkill Technology Center use only: 2019-2020 APPLICATION FOR ADMISSION CIP Code choice #1 CIP Code choice #2 Home School Counselor Section A Cycle B Cycle Schuylkill Enrollment Technology Date: Center. All incomplete applications will Program be returned Name: to home school. STC Checklist of items received: Transcript Most Recent Report Card Grade 8 PSSA report Last Name First Name (Full name/ No nicknames) MI Current Reading levels Current Math Levels Grade 11 Keystone PA Secure ID Last Math report Course Completed: Current IEP 504 Plan Interest/ Aptitude results To be a completed application, please make sure application is complete (signatures and attachments) before sending to 8th or 11 th Grade PSSA/Keystone Scores: Reading Writing Math: Circle Current Grade:8 9 10 11 12 Current Reading levels (list source used) Current Math Levels (list source used) Career Interest Survey Results: (list source used) List the order in which Social Studies should be taken at STC: American Cultures I American Cultures I I Worlds Studies Civics/ Economics Special Accommodations: Support from Itinerant Learning Support Teachers Yes No Curriculum Type: Regular District Special Education I.U. Special Education: MAC SLA English Language Learner Home Language: Child Accounting Information: Racial/ Ethnic Category: American Indian/ Alaskan Native Asian Black (Non-Hispanic) Hispanic White (Non-Hispanic) Mutli- Racial Resident Pupil/ Non Resident Category: 1305 code: 1306 code: Sending School Counselor List of Attachments Grade 8 PSSA report/grade 11 Keystone report Current IEP Mid-year report card for current year 504 Plan Transcript for grade(s) completed to current year Interest/ Aptitude results PVAAS Scores Home School Guidance Signature: Date:
STC Guidance Signature: Date: Directions: Student/ Parents: 1. Students and parents must complete Schuylkill Technology Center Application. 2. Student must write an essay (pg 2 of application) 3. Return the completed Application for Admission to your home school s Guidance Counselor for processing. 4. Students who live in Schuylkill County and attend parochial schools, private schools, charter schools or are home schooled need to contact the school district in which they reside to obtain enrollment procedures. 5. If you have been accepted to STC and then move to a new school districts, you must reapply to STC via the new school district. District Personnel: 1. Review Student/ Parent section for completeness and then complete Home School Guidance Section. 2. Forward only completed applications (with supplemental information attached) to Schuylkill Technology Center for processing. 3. Each applicant will be reviewed by STC Guidance and STC Administration (and STC Special Education Department, if student requires supplemental educational services). Admission is granted based on predetermined district slots allocations. If all of the district s slots are utilized, the remaining applications are then placed on a waiting list for potential placement as openings occur in those programs. 4. Transfer students that have previously been accepted into STC must reapply to STC when they enroll in your district. Checklist for Application to Schuylkill Technology Centers: Express a desire to learn a trade and a desire to attend Schuylkill Technology Center Work independently with minimal supervision to complete a task Stay focus on class work and assignments for extended periods of time. Get along with fellow students and coworkers. Deal with individuals with different work styles and points of view. Resolve conflicts in an appropriate manner other than physical or verbal abuse. Follow multiple step verbal directions. Perform basic math operations (addition, subtraction, multiplication, division) Additional Checklist for Application to Schuylkill Technology Center with Support from Itinerant Learning Support Teachers:
Visit program of interest prior to IEP meeting scheduled by the sending district and is to be attended by STC Special Education staff with input from STC Vocational Staff. The IEP must reflect placement in the STC as well as the level of support provided Current Reading and Math Levels