CTC Application 2022-2023
Application for New CTC Students

*By filling out this form; you are permitting school records to be sent and shared with the CTC.
The Greene County Career and Technology Center does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquires may be directed to the Greene County Career and Technology’s Title IX Coordinator or the Section 504 Coordinator at 60 Zimmerman Drive, Waynesburg, PA or call 724-627-3106.


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School District: *
First Name: *
Middle Name:
Last Name: *
Student School Email Address *
Graduation Year: *
FIRST Program Choice:   (Due to enrollment numbers, you are not guaranteed your first program choice, however we will try our best to accommodate your program of choice.) *
SECOND Program Choice *
THIRD Program Choice *
MAILING Address: *
City, State and Zip Code: *
Birth Date: *
MM
/
DD
/
YYYY
Father/Guardian Name (First and Last): *
Father/Guardian Employer:
Father/Guardian Email Address: *
Father/Guardian Cell Phone Number: *
Father/Guardian Home Phone Number:
Father/Guardian Work Phone Number:
Mother/Guardian Name (First and Last): *
Mother/Guardian Employer:
Mother/Guardian Email Address: *
Mother/Guardian Cell Phone Number: *
Mother/Guardian Home Phone Number:
Mother/Guardian Work Phone Number:
Shirt Size *
Jacket Size *
Pant Size *
Handedness *
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