WRCC Program Application
This application is for day programs only. If you are registering for Adult Education classes, please use the Adult Ed Application.
Student's Name (First, Last) *
Your answer
Mailing Address (Street, City, State, Zip) *
Your answer
Physical Address (Street, City, State, Zip)
Your answer
Legal Town of Residence *
Your answer
Home High School *
Grade *
Your answer
Date of Birth
MM
/
DD
/
YYYY
Gender Identity
Your answer
Student Cell Phone
Your answer
Student Email *
Your answer
I would like to apply for: (list 1st & 2nd choices) *
Your answer
About You *
Yes
No
Are you a new student to WRCC?
Are you a returning 2nd year student?
How did you learn about WRCC?
Parent/Guardian #1 (First, Last) *
Your answer
Relationship *
Your answer
Address (Street, City, State, Zip) *
Your answer
Parent/Guardian #2 (First, Last)
Your answer
Relationship
Your answer
Home Telephone #
Your answer
Work Telephone #
Your answer
Cell Phone #
Your answer
Email
Your answer
Student Signature
By signing this application, all parties agree that the student meets the prerequisite requirements as described in the WRCC Admissions Policy for the program to which the student is applying or that a reasonable plan to meet the prerequisites has been developed with the Windham Regional Career Center instructor and staff.
Student Access
In accordance with Title VI of the Civil Rights Act of 1964, Title IX of the Higher Education Act of 1972, Section 504 and the Americans with Disabilities Act, and the rules and regulations promulgated by the Secretary of Health, Education and Welfare, it is the policy of the Windham Regional Career Center that no person, upon the basis of race, color, national origin, creed or faith, gender or age, sexual orientation or handicapping conditions and/or disability, shall be excluded from participation, denied the privileges of, or be subjected to discrimination in any educational program or activity at the Center.
Please sign: *
Your answer
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