Patoka Valley Career and Technical Cooperative Online Application
Instructions: All students planning to enroll in a Career and Technical Education program must complete this pre-enrollment form.

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.

What school do you currently attend *
Required
Last Name *
Your answer
First Name *
Your answer
Parent/Guardian Names *
Your answer
Home Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Cell Phone Number *
Your answer
Grade for Next Year (2018-2019) *
Required
Date of Birth *
MM
/
DD
/
YYYY
What is your personal email address?
Your answer
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