CTE Student Enrollment Form
2018-19 School Year
Last Name *
Your answer
First Name *
Your answer
1st Choice Program *
2nd Choice Program *
3rd Choice Program *
High School You Attend *
Grade For 2018-2019 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/Mailing Address *
Your answer
City, State, Zip *
Parent/Guardian Name *
Your answer
Parent/Guardian Phone Number (123)123-1234 *
Your answer
Parent/Guardian Email Address *
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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