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Blissfield Student Application for 2020-2021
LISD TECH Center
1372 N. Main Street
Adrian, MI 49221
517-265-1659
www.lisd.us/lisd-tech-center
First Name *
Your answer
Last Name *
Your answer
Street Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
School Attending *
Current Grade *
Student Home Phone
Your answer
Student Cell Phone
Your answer
Student E-mail Address
Your answer
Name(s) of Parent/Guardian Student Lives With *
Your answer
Parent/Guardian E-mail Address
Your answer
First Choice *
Second Choice
Preferred Session *
I have discussed my decision to enroll in a program at the LISD TECH Center with my parent/guardian. *
I have discussed my decision to enroll in a program at the LISD TECH Center with my high school counselor. *
Work-Based Learning (earn high school credit while working)
If you selected Work-Based Learning as one of your choices, please answer the questions below.
I have made contact with an employer
Business Name (If made contact with employer, please fill out)
Your answer
Supervisor Name
Your answer
Supervisor Phone Number
Your answer
Employment interest (type of work)
Your answer
I am currently enrolled in OR have successfully completed an LISD TECH Center program, and I am interested in a paid Co-op opportunity.
LISD TECH Center Program
Your answer
Work-Based Learning Placements are not guaranteed. If I do NOT get a placement:
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