Off Campus Programs Request Form

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Please complete this form to arrange an appointment with Ms. Johnson. Thank you.

Student Last Name *

Student First Name *

Please list your cell phone # *

Grade *

10th (Technical College Only)

11th

12th

What Program do you wish to apply for? *

CCI

Dual Enrollment

PLC

If you plan to apply to CCI, which program do you wish to apply for?

Automotive (2 semesters)

Computer Information Systems (2 semesters)

Cosmetology (2 Semesters)

Criminal Justice (2 Semesters)

Culinary Arts (2 Semesters)

Dental Assisting (Must be 16 or older) (3 Semesters)

Early Childhood Education (ECE) (2 Semesters)

Game Development Specialist (2 Semesters)

Patient Care Assisting (Must be 17 as of Feb. 1st) (2 Semesters)

Pharmacy (Must be 16 or older) (3 Semesters)

Welding (2 Semesters)

If you plan on participating in the Dual Enrollment Program, Which College are you applying to?

Georgia HIghlands College (GHC)

University of West Georgia (UWG)

West Georgia Technical College (WGT)

Other (Please List)

Other:

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This form was created inside of Douglas County School System.