2017-18 NEW STUDENT APPLICATION Please return to your high school guidance office by Full Student Name: First name (no nicknames) Full Middle Name Last High School Place a number one (1) in front of your first choice and a two (2) in front of your second choice. = Brownstown Campus, = Mount Joy Campus, = Willow Street Campus Part 1 Program Selection(s) and Contact Infmation FULL DAY PROGRAMS (senis only) Lancaster County Career & Technology Center Program Offerings CLUSTER PROGRAMS (junis only-half day) Animal Production Science & Technology,, Construction Cluster Architectural CAD/Design,, Culinary Cluster Automotive Mechanics,, Health Care Cluster Automotive Technology, Manufacturing Cluster Baking & Pastry Arts,, Transptation Cluster Cabinetmaking & Wood Technology, Visual Communications Cluster Clinical Care Assistant Collision Repair HALF DAY PROGRAM (senis only) Commercial Art,, Advanced Health Careers (fmerly Intro to Health Careers) Commercial Construction/Management Computer Systems Technology, Cosmetology Culinary Arts/Chef Dental Assistant Diesel Equipment Technology Digital Design/Print Media Early Childhood Education Electrical Construction Technology Electro-Mechanical Engineering Tech Event Planning & Tourism Services Management Heavy Equipment Operation & Maintenance HVAC/R Medical Administrative Assistant Medical Assistant Nursing Assistant/Home Health Aide Painting/Ceramic Tile & Vinyl Photography and Digital Imaging Plumbing Precision Machining & Computer Aided Manufacturing Protective Services Academy Residential Carpentry RV & Outdo Power Equipment Sheet Metal Technology Spts Medicine/Rehabilitation Technician Veterinary Assistant Welding ***Choices CANNOT be changed during the selection process. Counsels will be notified when selection is complete. High School Guidance Use Only: Cluster Campus Cluster Session AM PM Cosmetology Campus Continued on Next Page
To be completed by Applicant & Parent Legal Guardian: Signatures Required Full Student Name: Home Telephone: ( (no nicknames) First Middle Name Last ) Address: Student Cell Phone: ( ) Street City State Zip Date of Birth: Student Email Address: Gender: Male Female F mandaty Pennsylvania Department of Education state repting purposes, please complete the ethnicity and race boxes. Ethnicity: Hispanic/Latino Not Hispanic/Latino Race: Choose one me IF MORE THAN ONE, ENTER A P NEXT TO THE PRIMARY RACE American Indian/Alaskan Native (not Hispanic) Asian Black (not Hispanic) Hispanic White (not-hispanic) Native Hawaiian Other Pacific Islander (not Hispanic) STUDENT CONTACT INFORMATION: TO BE COMPLETED BY PARENT/GUARDIAN PRIMARY CONTACT: Does Student Reside with Primary Contact? Yes No Mother Father Guardian Other (specify relationship) Name of Primary Contact: First Middle Last Address if not same as student: Street Address City State Zip Email Address: Home Phone Number: Wk Number & Ext. Cell Number Should Primary Contact Receive Crespondence: Yes No SECONDARY CONTACT: Does Student Reside with Secondary Contact? Yes No Mother Father Guardian Other (specify relationship) Name of Secondary Contact: First Middle Last Address if not same as student: Street Address City State Zip Email Address: Home Phone Number: Wk Number & Ext. Cell Number Should Primary Contact Receive Crespondence: Yes No EMERGENCY CONTACT: Does Student Reside with Emergency Contact? Yes No Mother Father Guardian Other (specify relationship) Name of Emergency Contact: First Middle Last Address if not same as student: Street Address City State Zip Email Address: Home Phone Number: Wk Number & Ext. Cell Number Should Primary Contact Receive Crespondence: Yes No 2
Parental Consent I, as parent guardian of the student who has completed Part 1, give permission f my son/daughter to apply f admission into the Lancaster County Career & Technology Center course(s) checked in the student data section. I have reviewed the Program Infmation Sheets f all programs selected and understand the associated costs f enrollment in these programs https://lancasterctc.edu/17-18-program-guide/. Furtherme, I am also aware that copies of the school recds f my son/daughter will be fwarded to the LCCTC by the sending school counsel. I give permission f my child to participate in an approved career and technical education program under the authity of the Lancaster County Career & Technology Center. This course may involve operation of power machinery and/ wking with electrical components. It is the policy of this school to teach the safe use of all tools and equipment involved in the instructional program. Reasonable precautions are taken to avoid accident injury to the students others within that instructional area. I understand that there are risks involved in providing career and technical education. Signature of Parent/Legal Guardian Date COPIES OF THE APPLICATION ARE AVAILABLE FROM YOUR HIGH SCHOOL COUNSELOR OR ON THE LCCTC WEBSITE: www.lancasterctc.edu The Lancaster County Career & Technology Center does not discriminate on the basis of race, col, national igin, sex, disability age in its programs activities. Career and technical education program offerings include: healthcare; public safety; consumer services; transptation, construction, advanced manufacturing, visual communications; and culinary arts. Admission criteria is available and can be found on the Lancaster County Career & Technology Center website. Inquiries may be directed to the Supervis of Student Services and Title IX Codinat the Section 504 Codinat at 1730 Hans Herr Drive, Willow Street, PA 17584 717-464-7050. F infmation regarding the Americans with Disabilities Act (ADA), the rights of an individual with a disability, our obligations under ADA, grievance procedures, contact the Business Manager and ADA Codinat, 1730 Hans Herr Drive, PO Box 527, Willow Street, PA 17584-0527. Telephone: 717-464-7050. F inquiries regarding other nondiscriminaty policies and programs, f infmation regarding services, activities, programs and facilities that are accessible to and usable by both disabled persons and national igin minity persons who lack English language skills, contact the Supervis of Student Services and Codinat f Title VI, Title IX and Section 504 1730 Hans Herr Drive, P.O. Box 527, Willow Street, PA 17584. Telephone: 717-464-7050. All students must have a Teacher Recommendation Fm completed by a teacher whose class you completed (fmer current teacher) preferably related to your CTC Program of Study. Please list which teacher received your fm. Teacher Name No changes to program choices are permitted during the selection process (End of January through mid-march) Note: If student changes districts after application is submitted and their program choice(s) is/are offered at different campuses, they are not guaranteed a spot at the other campus. 3
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Part 2 - To be completed by Sending School Counsel Please Check District of Residence: Cocalico Donegal Ephrata Manheim Central Pequea Valley Warwick Columbia Eastern Lancaster County Hempfield Manheim Township School District of Lancaster Conestoga Valley Elizabethtown Lampeter Strasburg Penn Man Solanco Please Check School Attending: Cocalico Eastern Lancaster County Columbia Elizabethtown Janus School Conestoga Valley Ephrata JP McCaskey Dayspring Christian Grandview Heights Donegal Homeschooled Other: Hempfield Lancaster Catholic Manheim Central Pequea Valley Lancaster County Christian Lancaster Mennonite Please Check Special Populations Designation(s) (all that apply) Manheim Township Mt. Calvary Phoenix Academy Solanco Lampeter Strasburg Lititz Christian Penn Man Warwick Not Applicable GIEP w/ Disability 504 Plan IEP GIEP w/o Disability Limited English Proficiency Single Parent Incl. Pregnancy Migrant Disability Code(s) (if multiple, enter P f primary and S f all secondary) Autistic/Autism Hearing Impairment incl. deafness Orthopedic Impairment Speech Language Impairment Alternative Ed Visual Impairment Incl. Blindness Emotional Disturbance Deaf/Blindness Intellectual Disability Specific Learning Disability Traumatic Brain Injury Other Health Impairment *Above Data is f State Repting Purposes (PIMS) only. It will not be considered as part of the selection process Projected Grade Level during 2017-2018 School Year: Projected Graduation Year: Student PASecureID: Counsel Check Off: Official Transcript Order: Application, Teacher Recommendation, Transcript No staples please Sending School Counsel (Please Print) Sending School Counsel Signature Date 5
SELECTION CRITERIA AND SCORING (To Be Completed by a Sending District Counsel) 1. Attendance (25 pts) Based upon total days absent (excused and unexcused) from previous full school year through November 30, Circle the total days absent and the cresponding point value as shown below. Explain excessive absences in comments section below. Points Days Absent 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25+ Points 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1 0 2. Citizenship (25 pts) Based on the descriptions below, circle the number most representative of the student s citizenship from pri year through November 30 of the current year. 25 20 10 5 0 Points Demonstrates self-discipline and positive regard f others. Generally self-disciplined and respectful to others. Generally self-disciplined and respectful to others. Lacks self-discipline and respect f others. Lacks self-discipline and respect f others. No disciplinary incidents 1 disciplinary infraction 2 disciplinary infractions 3 disciplinary infractions 4 me disciplinary infractions 3. Academic Readiness (33 pts) a. Academic Rig Choose the categy that cresponds to the level of the student s academic coursewk. Points Highly Rigous - 3 Rigous - 2 Less Rigous - 1 Most courses are CP, Hons, and AP Majity of courses are considered CP Most courses are non-cp level b. Academic Grades Circle the number that represents the student s unweighted GPA during their high school career. Points Percentage Average/Unweighted GPA 94-100% 3.69-4.00 90-93% 3.29-3.70 87-89% 2.69-3.30 83-86% 2.39-2.70 80-82% 1.99-2.30 77-79% 1.69-2.00 73-76% 1.39-1.70 70-72%.99-1.30 Points 10 9 8 7 6 5 4 3 0 c. Credit Status Circle the number that best represents the student s current credit status. Points 10 0 <=69% <=.98 On track with appropriate credits/grade level f CTC program. Special Needs student on track to graduate with IEP goals. Currently sht credits f appropriate credits/grade level f CTC program d. Failed Classes Circle the number that cresponds with the number of courses the student failed during their high school career. Points 10 6 3 0 Student failed 0 classes Student failed 1 class Student failed 2 classes Student failed 3+ classes Comments: Use this space to qualify ANY of the selection criteria ratings. F example, a medical condition may have caused excessive absenteeism. Extra points may be awarded by the LCCTC Student Services department based on these qualifications mitigating circumstances. 4. Teacher Recommendation (12 pts) Student applicant should obtain one teacher recommendation from a teacher whose class they completed; teachers will return the recommendations to the high school guidance office to be submitted to LCCTC with the application package. Current Cluster student teacher recommendations will be codinated by the LCCTC Counsel. Points Returning Student Total Recommendation Sce 5 + 2 = New Student Total Recommendation Sce 5 = 5. Application Submission Date (3 pts) Student submitted the application on time to CTC. Points Yes Add 3 points I have reviewed the selection criteria and sces provided f this applicant and verify their accuracy. Counsel Signature CTC Cod. Counsel Initials TOTAL POINTS 6
Lancaster County Career & Technology Center TEACHER RECOMMENDATION ***Must be completed by Teacher whose class you completed (fmer current teacher) preferably related to your CTC Program of Study NAME OF STUDENT: PROGRAM CHOICE: SENDING SCHOOL: Teacher: The student has made application to the Lancaster County Career & Technology Center. Please evaluate this individual on qualities numbered 1-10. Please circle the box that best describes the student and return to the Guidance Office. PERSONAL FACTORS 5 4 3 2 1 1. COOPERATION: Willingness to wk well with others, f benefit of all, agreeable 2. ATTITUDE TOWARD AUTHORITY: Willingness to follow directives and respond positively toward teachers and administrats 3. ATTITUDE TOWARD LEARNING: Willingness to learn new knowledge techniques toward greater efficiency and growth 4. LEARNING RATE: Ability to learn new tasks master new routines quickly. 5. RESOURCEFULNESS: Devises ways and means to get job done; applies imagination and ingenuity to problem solving. 6. INITIATIVE: Self starter; motivated 7. RESPONSIBILITY: Dependable & reliable, carries out tasks in timely fashion 8. QUANTITY OF WORK: Volume of wk production/output 9. QUALITY OF WORK: Accuracy of wk completed 10. SAFETY: Follows rules; careful & ganized SCORE SUMMARY COLUMN TOTALS Always cooperative Usually cooperative Cooperative Reluctant to cooperate Openly uncooperative Understands and appreciates need f authity Constantly seeks additional training Very apt, needs little instruction Exceptional capacity f problem solving Always self-reliant & motivated Always dependable; assumes much responsibility Highest producer Consistently high quality & exceeds standards Always careful & ganized Shows evidence of accepting authity well Willingly accepts training Learns readily in a sht time Usually resourceful & creative Almost always self-reliant & motivated Very dependable & reliable Produces me than required Often exceeds standards Almost always careful & ganized Appears to accept authity reasonably well Accepts training if sees advantage Learns without difficulty Generally resourceful Usually shows initiative & motivation Usually dependable& reliable Average output Usually meets standards Usually careful & ganized Accepts authity with resistance Accepts training only under pressure Learns slowly with efft Limited problem solving skills Limited initiative & motivation Somewhat dependable Barely meets output minimum Wk often incomplete & below standards Often careless & disganized Definitely resists authity Definitely resists Learning is extremely difficult Lacks resourcefulness & problem solving skills Lacks initiative & motivation Unreliable Unsatisfacty output Wk rarely complete & always below standards Dangerously careless & extremely disganized TEACHER S SIGNATURE SUBJECT TAUGHT TEACHER S NAME (print) DATE TOTAL SCORE: 7