Enrollment Application 2014-2015 School Year Question Title * 1. Student Information Student First Name: * Student Last Name: * Student Cell # - Include Area Code: Mailing Address: * City: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Zip: * Home Phone # - Include Area Code Parent Cell # - Include Area Code: Student Email: Question Title * 2. Name of Home High School ADULT PPEP Tech Home Schooled Arizona Virtual Casa Verde HS Casa Grande Union HS Coolidge HS Desert Winds HS Florence HS Florence Virtual School Imagine Prep HS Ira Hayes School Legacy School Maricopa HS Mission Prep School Poston Butte HS Santa Cruz Valley UHS San Tan Foothills HS Sequoia Maricopa VHM Villa Oasis School Vista Grande HS Question Title * 3. Current Grade Level 10 11 12 Question Title * 4. Student's 1st Program Choice Aesthetics CAVITConnect Law Enforcement CAVITConnect Veterinary Assistant CAVITConnect Allied Health Cosmetology Dental Assistant Fire Science Law Enforcement Massage Therapy Medical Assistant Nursing Assistant Veterinary Assistant Question Title * 5. Student's 2nd Program Choice Aesthetics Cosmetology Dental Assistant Fire Science Law Enforcement Massage Therapy Medical Assistant Nursing Assistant Veterinary Assistant Question Title * 6. If you cannot fit CAVIT into your schedule or your school does not allow you to attend due to AIMS/credit issues; would you be interested in attending CAVIT's evening program two days per week? (Students would be responsible for their own transportation to an evening program.) No Yes Question Title * 7. Are you currently being served in your school's Free/Reduced Lunch Program? No Yes Question Title * 8. Do You Receive Any of These Services? No Yes ESL/ELL ESL/ELL No ESL/ELL Yes IEP or Special Ed IEP or Special Ed No IEP or Special Ed Yes 504 504 No 504 Yes Question Title * 9. How did you hear about CAVIT? Friend Counselor Presentation CAVIT Showcase Newspaper Mailing Done