Central Nine Career Center On-line Application
School Year of Attendance *
Sending High School *
Student First Name *
Your answer
Student Middle Initial *
Your answer
Student Last Name *
Your answer
Current Grade Level *
Date of Birth *
MM
/
DD
/
YYYY
Social Security Number
We are required to ask for federal and state reporting responsibilities.
Your answer
Gender *
Student Phone Number
List cell phone if available
Your answer
Legal Parent/Guardian First Name *
Start with the parent you live with or would be most involved in checking your school progress.
Your answer
Legal Parent/Guardian Last Name *
Your answer
Legal Parent/Guardian Relationship to student *
Legal Parent/Guardian Phone Number
Use preferred phone contact number where messages are regularly checked.
Your answer
Address *
Your answer
City *
Your answer
State *
Zip Code *
Your answer
Student Email Address
Your answer
Parent/Guardian Email Address
Your answer
Are you a current C9 student? *
School Year 2015-2016
Current Program
(if applicable)
Program Choice for next year *
There is no guarantee of placement; please include a second and third choice.
Second Program Choice for next year *
There is no guarantee of placement; please include a second and third choice.
Third Program Choice for next year
There is no guarantee of placement; please include a second and third choice.
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