Canton City School District                         Adult Career & Technical Education       Admission Application
Background Information
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521 Tuscarawas Street W., Canton, OH 44702 ~ (330) 438-2556  ext:11504
First Name: *
Middle Initial: *
Last Name:  *
Any Previous Names or Aliases:
Birthdate MM/DD/YYYY (Allowed to type "prefer not to answer".) *
Street Address (House Number, Street Name, Street Direction if applicable): *
City:  *
State: *
Zip Code: *
Email Address:  *
Cell Phone: *
Can you receive text messages?  *
Other Phone:
Gender: *
Are you a US Citizen? *
If you answered "No" to the question above, please explain.
Are you a Veteran? *
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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