Millstream Career Center Application
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Student Information
Completing this online application is the first step in your application process for the 2017-2018 school year. You must be a student in one of our 16 associate schools to be eligible to attend Millstream. Please complete all fields.
Student First Name *
Your answer
Student Middle Name *
Your answer
Student Last Name *
Your answer
Date of Birth *
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DD
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YYYY
Primary Phone Number *
Your answer
Student eMail Address
Your answer
Student Gender *
Student Home Address *
Your answer
City *
Your answer
Zip Code *
Your answer
Which Associate School do you Attend? *
Please note that all students who attend Millstream programs must attend one of our 16 associate schools.
Current Grade in School *
Required
Parent/Guardian Information
Please provide contact information for one Parent or Guardian who resides with the student and consents to the processing of this application.
Relationship to Student *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian eMail Address
Your answer
Program Information
Which Millstream programs would you like your application to be considered for?
Indicate your first choice of career training programs. *
CC+ Indicates the possiblity of receiving college credit at Millstream Career Center
Indicate your second choice of career training programs. *
CC+ Indicates the possiblity of receiving college credit at Millstream Career Center
Electronic Agreements
I certify that all statements I have made in this application are true, complete, and correct to the best of my knowledge; and that I am aware that any false statements, misrepresentations, or omissions of the facts will be sufficient cause for dismissal. I understand there are school fees required for this program. I acknowledge that I am forwarding this application to Millstream electronically and that I have agreed to conduct this transaction electronically with the permission of a parent or guardian. *
I understand that students are considered for admission to Millstream Career Center on the basis of scholastic record, attendance, interest in a career area, career assessment, and counselor recommendation. I understand that failure to maintain acceptable grades and attendance during the second semester of 2016-2017 may lead to a loss of program acceptance. *
I understand that if I am accepted in a Millstream program, I am making a commitment to complete the program. Withdrawing from a program can only be completed in writing with a parent signature and reason for withdrawing. Students who do not withdraw from a program prior to June 1 will be required to begin the program in the fall. By completing the application I am agreeing to adhere to Millstream's attendance policy. *
Equal Opportunity Institution
In accordance with Title VI, Title IX and Section 504, Millstream Career Center is an equal opportunity institution. Educational activities, employment practices, programs and services are offered without regard to race, color, national origin, sex, age, disability, military status or socio-economic status. We provide equal access to the Boy Scouts and other designated youth groups.
Did a current Millstream student speak to you about Millstream as part of our Refer a Friend Program?
If so, please list their first and last names.
Your answer
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