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Canton City School District Adult Career & Technical Education Admission Application
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Email
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Your email
521 Tuscarawas Street W., Canton, OH 44702 ~ (330) 438-2556 ext:11504
First Name:
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Your answer
Middle Initial:
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Your answer
Last Name:
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Your answer
Any Previous Names or Aliases:
Your answer
Birthdate MM/DD/YYYY (Allowed to type "prefer not to answer".)
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Your answer
Street Address (House Number, Street Name, Street Direction if applicable):
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Your answer
City:
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Your answer
State:
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Your answer
Zip Code:
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Your answer
Email Address:
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Your answer
Cell Phone:
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Your answer
Can you receive text messages?
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Yes
No
Other:
Other Phone:
Your answer
Gender:
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Female
Male
Prefer not to say
Are you a US Citizen?
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Yes
No
If you answered "No" to the question above, please explain.
Your answer
Are you a Veteran?
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Yes
No
I would like to enroll in the following program:
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Medical Assistant (9 months/1,040 Hours) - Enrolling for 2025-2026
Medical Insurance Billing & Coding (9 months/1,020 Hours) - Enrolling for 2025-2026
Practical Nurse (11 months/1,200 Hours) - Enrolling for 2025-2026
State Tested Nurse Assistant (STNA) (3 weeks/91 Hours) - Enrolling now, new classes monthly!
Welding (45 weeks/800 hours) - Enrolling for 2025-2026
Other:
Desired Enrollment Date:
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As Soon As Possible
Fall 2025
Option 3
Other:
Secondary Person to Contact about your Application if you cannot be reached: (Their Name, Their Cell Phone, Their Relationship to you):
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Your answer
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