Enrollment Application 2014-2015 School Year

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* 1. Student Information

Student First Name: *

Student Last Name: *

Student Cell # - Include Area Code:

Mailing Address: *

City: *

State: *

Zip: *

Home Phone # - Include Area Code

Parent Cell # - Include Area Code:

Student Email:

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* 2. Name of Home High School

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* 3. Current Grade Level

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* 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

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* 5. Student's 2nd Program Choice

Aesthetics

Cosmetology

Dental Assistant

Fire Science

Law Enforcement

Massage Therapy

Medical Assistant

Nursing Assistant

Veterinary Assistant

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* 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.)

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* 7. Are you currently being served in your school's Free/Reduced Lunch Program?

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* 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

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* 1. Student Information

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* 2. Name of Home High School

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* 3. Current Grade Level

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* 4. Student's 1st Program Choice

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* 5. Student's 2nd Program Choice

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* 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.)

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* 7. Are you currently being served in your school's Free/Reduced Lunch Program?

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* 8. Do You Receive Any of These Services?

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* 9. How did you hear about CAVIT?