Adult Career and Technical Education Admission Application
Background Information
Email address *
2800 13th St. S.W., Canton, OH 44710 ~ (330) 438-2556 ext:101
First Name: *
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Middle Initial: *
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Last Name: *
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Any Previous Names or Aliases:
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Street Address (House Number, Street Name, Street Direction if applicable): *
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City: *
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State: *
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Zip Code: *
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Email Address: *
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Cell Phone: *
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Can you receive text messages? *
Other Phone:
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Gender: *
I would like to enroll in the following program: *
Desired Enrollment Date: *
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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