Twin Rivers Online Application 18-19
Instructions: All students planning to enroll in a Twin Rivers Career and Technical program must complete this form.
High School - What school do you CURRENTLY attend? *
First Name *
Your answer
Last Name *
Your answer
MI - Middle Initial *
Your answer
Parent/Guardian First & Last Name *
Your answer
Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Student Cell # *
Your answer
Student Email Address *
Your answer
Parent/Guardian Cell # *
Your answer
Parent/Guardian Email Address *
Your answer
Emergency Contact Name and Cell# if Parent/Guardian is not available. *
Your answer
Date of Birth (10/25/1999) *
Your answer
Age - Current Age of Student *
Your answer
M/F - Male/Female *
SSN - Social Security Number (Must have for dual credit) *
Your answer
Current Year in School *
Grad Year - What year will you graduate high school? *
Drivers license. Will you have a drivers license by the start of next school year? *
Medical Conditions - List any medical conditions or allergies we should be aware of.
Your answer
Hoodie Size - What size hoodie do you wear? *
Captionless Image
1st Choice Program - What Twin Rivers program (1st Choice) are you interested in? *
1st Yr/2nd Yr - If you are given your 1st choice above, would you be a first year student or a second year student in that specific Twin Rivers program? *
2nd Choice Program - Twin Rivers Program (2nd Choice) if 1st Choice is not available. (This is not required)
1st Yr/2nd Yr - If you are given your 2nd choice above, would you be a first year student or a second year student in that specific Twin Rivers program?
"We agree and understand the program will be for the entire school year and that tuition cost may occur back to the student if the program is dropped anytime after April 15th of this year." *
"We agree the student shall abide by all Twin Rivers Career & Technical Education Area rules, regulations and policies as defined by the Student Handbook that is located at: http://twinriversarea.org/student-handbook/". We have access to the online student handbook. *
We hereby authorize Twin Rivers Career & Technical Education Area to exhibit and/or distribute pictures of the student for publicity and recruitment purposes without limitation. *
The student has permission to drive to his/her Twin Rivers Career & Technical Education Area class. We understand it is the responsibility of each student to provide their own transportation to the class/lab. *
During the school year, it may be necessary for the student to drive his/her vehicle to class related activities, to pick up and/or order supplies and/or equipment. *
Twin Rivers Career & Technical Education Area cannot, and does not, accept liability for any injury that might occur to the student learner while carrying out the conditions of the program. *
Twin Rivers Career & Technical Education Area needs to know the health/accident insurance status of each student enrolled in a Twin Rivers Career & Technical Education Area program. *
"We agree to either purchase school insurance or show proof of accident or health insurance for the student." *
We have read and understand the Internet Use Policy found at: http://twinriversarea.org/wp-content/uploads/2016/07/Internet-use-policy.pdf *
We give Twin Rivers CTE Area permission to accept all dual credit applications forms from both Vincennes University or Ivy Tech Community College on our behalf. *
Additional Comments for Twin Rivers Staff to Consider:
Your answer
Student Electronic Signature - Type your First and Last Name (By signing below you are indicating that all the information on this application is accurate to the best of your knowledge.) *
Your answer
Date of Signature *
Your answer
Parent Electronic Signature - Type your First and Last Name (By signing below you are indicating that all the information on this application is accurate to the best of your knowledge.) *
Your answer
Date of Signature *
Your answer
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