Student InformationThis field is hidden when viewing the formSchool YearStudent Name(Required) First Last Student WVEIS Number(Required)Student Phone Number(Required)Student Email(Required) What High School do you attend?(Required) Capital High George Washington High Herbert Hoover High Nitro High Riverside High Saint Albans High Sissonville High South Charleston High Home School Private School Current Grade?(Required) 9th 10th 11th 12th Parent/Guardian Name(Required) First Last Parent/Guardian Phone Number(Required)ProgramsList of programs available at each location Ben Franklin Career Center Carver Career & Technical Center Animal Systems (1 yr program) Automotive Technology (2 yr program) Carpentry (2 yr program) Coding, AI & Game Design (1 yr program) Computer Systems Networking and Repair (1 yr program) Diesel Equipment Technologies (2 yr program) Early Childhood Education (1 yr program) Electrical Technician (2 yr program) Entrepreneurship (1 yr program) Health Occupations – Therapeutic Services (2 yr program) NOT OPEN to upcoming 10th grade students HVAC Technician (2 yr program) Law & Public Safety (1 yr program) Manufacturing – 4T Academy (2 yr program) Medical Assisting (2 yr program) NOT OPEN to upcoming 10 grade students Medical Assisting Honors (2 yr program) NOT OPEN to upcoming 10th grade students Machine Tool Technology (1 yr program) Pet Grooming (1 yr program) Power Equipment Systems (1 yr program) Pre-Nursing Honors (2 yr program)NOT OPEN to upcoming 10th grade students Tourism (1 yr program) Advanced Medical Preparedness Honors (1 yr program) NOT OPEN to upcoming 10th grade students Animal Systems (1 yr program) Automotive Technology (2 yr program) Baking and Pastry (1 yr program) Carpentry (2 yr program) Collision Repair (2 yr program) Dental Assisting (2 yr program) NOT OPEN to upcoming 10th grade students Electrical Technician (2 yr program) Emergency Services & Fire Management (2 yr program) EMT (2 yr program) Entrepreneurship (1 yr program) Firefighting (2 yr program) Graphic Design Honors (1 yr program) HVAC Technician (2 yr program) Industrial Robotics Honors (2 yr program) Marketing (1 yr program) Multimedia Publishing Honors (1 yr program) Nail Technician (2 yr program) NOT OPEN to upcoming 10th grade students Natural Resource Management (2 yr program) Plumbing (2 yr program) Prostart Restaurant Management (1 yr program) Sports Medicine – Dual Credit (2 yr program) NOT OPEN to upcoming 10th grade students Therapeutic Services Honors (2 yr program) NOT OPEN to upcoming 10th grade students Welding (2 yr program) Choice 1Location(Required)— Choose One —Ben Franklin Career CenterCarver Career & Technical CenterProgram(Required)— Choose One —Animal Systems (Not Available, Program Full)Automotive TechnologyCarpentryCoding, AI & Game DesignComputer Systems Networking and RepairDiesel Equipment Technologies (Not Available, Program Full)Early Childhood EducationElectrical Technician (Not Available, Program Full)EntrepreneurshipHealth Occupations – Therapeutic Services (Not Available, Program Full)HVAC Technician (Not Available, Program Full)Law & Public SafetyManufacturing – 4T Academy (Not Available, Program Full)Medical Assisting (Not Available, Program Full)Medical Assisting Honors (Not Available, Program Full)Machine Tool Technology (Not Available, Program Full)Pet Grooming (Not Available, Program Full)Power Equipment Systems (Not Available, Program Full)Pre-Nursing Honors (Not Available, Program Full)TourismProgram(Required)— Choose One —Advanced Medical Preparedness HonorsAnimal SystemsAutomotive TechnologyBaking and Pastry (Not Available, Program Full)CarpentryCollision RepairDental AssistingElectrical Technician (Not Available, Program Full)Emergency Services & Fire ManagementEMTEntrepreneurshipFirefightingGraphic Design HonorsHVAC TechnicianIndustrial Robotics HonorsMarketingMultimedia Publishing HonorsNail Technician (Not Available, Program Full)Natural Resource ManagementPlumbing (Not Available, Program Full)Prostart Restaurant Management (Not Available, Program Full)Sports MedicineTherapeutic Services HonorsWelding (Not Available, Program Full)Choice 2Location(Required)— Choose One —Ben Franklin Career CenterCarver Career & Technical CenterI am not interested in any other programsProgram(Required)— Choose One —Animal Systems (Not Available, Program Full)Automotive TechnologyCarpentryCoding, AI & Game DesignComputer Systems Networking and RepairDiesel Equipment Technologies (Not Available, Program Full)Early Childhood EducationElectrical Technician (Not Available, Program Full)EntrepreneurshipHealth Occupations – Therapeutic Services (Not Available, Program Full)HVAC Technician (Not Available, Program Full)Law & Public SafetyManufacturing – 4T Academy (Not Available, Program Full)Medical Assisting (Not Available, Program Full)Medical Assisting Honors (Not Available, Program Full)Machine Tool Technology (Not Available, Program Full)Pet Grooming (Not Available, Program Full)Power Equipment Systems (Not Available, Program Full)Pre-Nursing Honors (Not Available, Program Full)TourismProgram(Required)— Choose One —Advanced Medical Preparedness HonorsAnimal SystemsAutomotive TechnologyBaking and Pastry (Not Available, Program Full)CarpentryCollision RepairDental AssistingElectrical Technician (Not Available, Program Full)Emergency Services & Fire ManagementEMTEntrepreneurshipFirefightingGraphic Design HonorsHVAC TechnicianIndustrial Robotics HonorsMarketingMultimedia Publishing HonorsNail Technician (Not Available, Program Full)Natural Resource ManagementPlumbing (Not Available, Program Full)Prostart Restaurant Management (Not Available, Program Full)Sports MedicineTherapeutic Services HonorsWelding (Not Available, Program Full)Choice 3Location(Required)— Choose One —Ben Franklin Career CenterCarver Career & Technical CenterI am not interested in any other programsProgram(Required)— Choose One —Animal Systems (Not Available, Program Full)Automotive TechnologyCarpentryCoding, AI & Game DesignComputer Systems Networking and RepairDiesel Equipment Technologies (Not Available, Program Full)Early Childhood EducationElectrical Technician (Not Available, Program Full)EntrepreneurshipHealth Occupations – Therapeutic Services (Not Available, Program Full)HVAC Technician (Not Available, Program Full)Law & Public SafetyManufacturing – 4T Academy (Not Available, Program Full)Medical Assisting (Not Available, Program Full)Medical Assisting Honors (Not Available, Program Full)Machine Tool Technology (Not Available, Program Full)Pet Grooming (Not Available, Program Full)Power Equipment Systems (Not Available, Program Full)Pre-Nursing Honors (Not Available, Program Full)TourismProgram(Required)— Choose One —Advanced Medical Preparedness HonorsAnimal SystemsAutomotive TechnologyBaking and Pastry (Not Available, Program Full)CarpentryCollision RepairDental AssistingElectrical Technician (Not Available, Program Full)Emergency Services & Fire ManagementEMTEntrepreneurshipFirefightingGraphic Design HonorsHVAC TechnicianIndustrial Robotics HonorsMarketingMultimedia Publishing HonorsNail Technician (Not Available, Program Full)Natural Resource ManagementPlumbing (Not Available, Program Full)Prostart Restaurant Management (Not Available, Program Full)Sports MedicineTherapeutic Services HonorsWelding (Not Available, Program Full)Choice 4Location(Required)— Choose One —Ben Franklin Career CenterCarver Career & Technical CenterI am not interested in any other programsProgram(Required)— Choose One —Animal Systems (Not Available, Program Full)Automotive TechnologyCarpentryCoding, AI & Game DesignComputer Systems Networking and RepairDiesel Equipment Technologies (Not Available, Program Full)Early Childhood EducationElectrical Technician (Not Available, Program Full)EntrepreneurshipHealth Occupations – Therapeutic Services (Not Available, Program Full)HVAC Technician (Not Available, Program Full)Law & Public SafetyManufacturing – 4T Academy (Not Available, Program Full)Medical Assisting (Not Available, Program Full)Medical Assisting Honors (Not Available, Program Full)Machine Tool Technology (Not Available, Program Full)Pet Grooming (Not Available, Program Full)Power Equipment Systems (Not Available, Program Full)Pre-Nursing Honors (Not Available, Program Full)TourismProgram(Required)— Choose One —Advanced Medical Preparedness HonorsAnimal SystemsAutomotive TechnologyBaking and Pastry (Not Available, Program Full)CarpentryCollision RepairDental AssistingElectrical Technician (Not Available, Program Full)Emergency Services & Fire ManagementEMTEntrepreneurshipFirefightingGraphic Design HonorsHVAC TechnicianIndustrial Robotics HonorsMarketingMultimedia Publishing HonorsNail Technician (Not Available, Program Full)Natural Resource ManagementPlumbing (Not Available, Program Full)Prostart Restaurant Management (Not Available, Program Full)Sports MedicineTherapeutic Services HonorsWelding (Not Available, Program Full)InterestWhy are you interested in these programs?(Required)This field is hidden when viewing the formChoice 1 AssigneeThis field is hidden when viewing the formChoice 1 Email This field is hidden when viewing the formChoice 2 AssigneeThis field is hidden when viewing the formChoice 2 Email This field is hidden when viewing the formChoice 3 AssigneeThis field is hidden when viewing the formChoice 3 Email This field is hidden when viewing the formChoice 4 AssigneeThis field is hidden when viewing the formChoice 4 Email
