Twin Rivers Online Application 26-27
Instructions: All students planning to enroll in a Twin Rivers Career and Technical program must complete this form.
For any questions regarding this application email jbridges@twinriversarea.org. 

The Twin Rivers Career & Technical Education Area does not discriminate on the basis of race, color, national origin, sex, disability, or age and provides equal access to its educational services, programs, instruction, and facilities.
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High School - What school do you CURRENTLY attend? *
First Name *
Last Name *
MI - Middle Initial *
Street Address *
City *
Zip Code *
Student Cell # *
Student Email Address *
Parent/Guardian First and Last Name *
Parent/Guardian Cell # *
Parent/Guardian Email Address *
Emergency Contact Name and Cell# if Parent/Guardian is not available *
Date of Birth (XX/XX/XXXX) *
Age - Current Age of Student *
M/F - Male/Female *
SSN - Social Security Number (Must have for dual credit) *
Current Year in School *
Grad Year - What year will you graduate high school? *
1st Choice Program - What Twin Rivers program (1st Choice) are you interested in? *
1st Yr/2nd Yr - If you are given your 1st choice above, would you be a first year student or a second year student in that specific Twin Rivers program? *
2nd Choice Program - Twin Rivers Program (2nd Choice) if 1st Choice is not available.  (This is not required)
1st Yr/2nd Yr - If you are given your 2nd choice above, would you be a first year student or a second year student in that specific Twin Rivers program?
Clear selection
Medical Conditions - List any medical conditions or allergies we should be aware of in case of emergency. This will not be used to determine eligibility to our programs.
Drivers license.  Will you have a drivers license by the start of next school year? *
"We agree the student shall abide by all Twin Rivers Career & Technical Education Area rules, regulations and policies as defined by the Student Handbook that is located at: http://twinriversarea.org/student-handbook/". We have access to the online student handbook. *
We hereby authorize Twin Rivers Career & Technical Education Area to exhibit and/or distribute pictures of the student for publicity and recruitment purposes without limitation. *
We hereby authorize school personnel to administer the recommended dosage of the following medications to my child while he/she is in attendance at school as the need may arise - Ibuprofen, Tylenol, Pepto Bismol, Tums, Hydrocortisone, Bacitracin, or Benadryl. *
The student has permission to drive to his/her Twin Rivers Career & Technical Education Area class.  We understand it is the responsibility of each student to provide their own reliable transportation to the class/lab. *
During the school year, it may be necessary for the student to drive his/her vehicle to class related activities, to pick up and/or order supplies and/or equipment. *
Twin Rivers Career & Technical Education Area cannot, and does not, accept liability for any injury that might occur to the student learner while carrying out the conditions of the program. *
We have read and understand the Internet Use Policy found at: http://twinriversarea.org/wp-content/uploads/2016/07/Internet-use-policy.pdf *
We give Twin Rivers CTE Area permission to accept all dual credit applications forms from both Vincennes University or Ivy Tech Community College on our behalf. *
How did you learn about Twin Rivers programs? *
Required
Additional comments for Twin Rivers staff to consider:
Student Electronic Signature - Type your First and Last Name (By signing below you are indicating that all the information on this application is accurate to the best of your knowledge.) *
Date of Signature *
Parent Electronic Signature - Type your First and Last Name (By signing below you are indicating that all the information on this application is accurate to the best of your knowledge.) *
Date of Signature *
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