2022-2023 Patoka Valley Career and Technical Cooperative Online Application

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Instructions: All students planning to enroll in a Career and Technical Education program must complete this pre-enrollment form. Submitting the application does not enter you directly into the selected CTE program. Students will be selected by CTE instructors through an interview process this spring.

This information is required to meet responsibilities of the Carl D. Perkins Career and Technical Education Improvement Act of 2006, Indiana Public Law 217, acts of 1987, and Indiana Public Law 105, Acts of 1994.

Email *

What school do you currently attend *

Southridge

Forest Park

NE Dubois

Pike Central

Jasper

Heritage Hills

Cannelton

Perry Central

Tell City

Required

Last Name *

First Name *

Parent/Guardian Names *

Home Address *

City *

Zip Code *

Cell Phone Number *

Grade for Next Year (22-23) *

Required

Date of Birth *

YYYY

What is your personal email address?

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