CHARIHOtech Online Application 2018-2019
Please be accurate with your submission. We will use the information you provide to contact you about acceptance decisions.
Student First Name *
Your answer
Student Last Name *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
First Choice Program *
Second Choice Program *
Third Choice Program *
Grade Entering 2019-2020 *
Present School *
Your answer
Guidance Counselors Name
Your answer
If not in school, last school attended
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Address: Street *
Your answer
Parent/Guardian Address: City *
Your answer
Parent/Guardian Address: State *
Parent/Guardian Address: Zip Code *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email Address *
Your answer
How did you hear about our CHARIHOtech programs? (check all that apply) *
Required
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