CTE Student Enrollment Form
Last Name
Your answer
First Name
Your answer
1st Choice Program
2nd Choice Program
3rd Choice Program
High School You Attend
Grade For 2017-2018 School Year
Year at Impact
(RETURNING STUDENTS) returning to same program select 2, if returning to Impact BUT to another program select 1
Date of Birth
MM
/
DD
/
YYYY
Street Address
Your answer
City, State, Zip
Parent/Guardian Name and Phone Number (123)123-1234
Your answer
Briefly describe why you want to be accepted into an Impact Institute program.
Your answer
List classes you have taken in high school and/or work experience that would relate to the Impact Institute program you are interested in.
Your answer
Please visit Impact Institute website to view student expectations, handbook, and video.
Impact Institute does not discriminate on the basis on race, color, national origin, sex, or disability.
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