daytime application 2016-2017 sallisaw campus · daytime application date of application: _____...
TRANSCRIPT
401 E. Houser Road Industrial Blvd., Sallisaw, OK 74955 P: 918-775-9119 F: 918-775-7305 www.ictctech.com
Date of Application: _____________ (Please print clearly when completing application)
Name:____________________________________________________________________________________ (First) (MI) (Last)
Mailing Address:____________________________________________________________________________ (Address) (City) (State) (Zip)
Home Phone:_____________ Cell Phone: ____________ Email:____________________________________
Emergency Contact: ___________________________________________________________ (Name) (Relation) (Phone)
(If selected as an ICTC student, please circle your t-shirt size) S M L XL 2XL 3XL 4XL
STUDENT INFORMATION RELEASE APPROVAL: This is an authorization for the local school district to release to Indian Capital the student records, including confidential records, concerning my son/daughter as they relate to determining appropriate enrollment. I hereby give approval to have my son/daughter attend ICTC once placement is determined. ________________________________________________ ______________ ______________________________________________ _____________
Signature of parent/guardian Date Signature of applicant Date
To Be Completed By High School Students Only Name of High School: __________________________ Current Grade Level:_____ Date of Birth:_________
Father/Guardian:_______________________________________________________________ (First Name) (Last Name) (Place of Employment)
___________________________________________________________________________ (Home Phone) (Cell Phone) (Work Phone) (E-Mail Address)
Mother/Guardian: ______________________________________________________________
(First Name) (Last Name) (Place of Employment)
___________________________________________________________________________ (Home Phone) (Cell Phone) (Work Phone) (E-Mail Address)
To Be Completed By Adult Students Only
Are you seeking financial aid? No Yes If you are seeking financial aid from any of the agencies such as WIA, TANF, VA, BIA, or Voc-Rehab, please list the agency and the counselor’s name: _____________________________________
Do you have a High School diploma? No Yes Do you have a GED? No Yes year_______________
Do you have educational records under any other name (i.e. maiden name)? No Yes If yes, what name: ___________________________
List other schools attended: __________________________________________ ___________ (School) (Year)
__________________________________________ ___________
(School) (Year)
Have you ever attended ICTC as a post-secondary day student? No Yes year ________
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Daytime Application 2016-2017
SALLISAW CAMPUS
Choose a Career Major from the following options:
I am interested in the following career major and would like to discuss it with an ICTC counselor:
1st Choice _______________________________________ 2nd Choice ____________________________________
I prefer to attend: _____AM (8:00 – 11:00) _____PM (12:00 – 3:00) _____Both (8:00 – 3:00) Adult only Which of the following influenced your decision to attend ICTC? Tech Fest Friend Relative Counselor ICTC Catalog ICTC Website Newspaper Advertisement Other (please specify) _____________________
Notice: Completion of this application by itself does not constitute admission to Indian Capital Technology Center. Please attach the following information to this application for it to be considered complete.
High School Checklist Adult Checklist
High School Transcript Transcript/GED Attendance Record Keytrain Results/Accuplacer PLAN Test Result Interest Inventory Interest Inventory (Contact ICTC for testing schedule)
An interview to discuss placement will be scheduled upon receipt of the application. Adults Only: After placement in an ICTC career major: If you have disabilities which require reasonable accommodations to perform the essential skills of
the career major, it is your responsibility to provide documentation and to notify your instructor or the student services coordinator. Non-Discrimination Statement: Indian Capital Technology Center is an equal opportunity institution in accordance with civil rights legislation and does not discriminate on the basis of race, color, religion, national origin, sex/gender, age, marital or veteran status, or disability in the operation of its educational programs, activities, recruitment and admission practices. Concerns regarding this policy should be addressed to Sharon Billings, District Compliance Coordinator, at 918-687-6383 or 1-800-375-8324, 2403 N. 41st Street E, Muskogee, OK 74403. Additionally, each campus has a contact in which complaints can be reported.
401 E. Houser Road Industrial Blvd., Sallisaw, OK 74955 P: 918-775-9119 F: 918-775-7305 www.ictctech.com
Auto Service Technology Automotive Service Technician (NATEF Compliant)
Construction Introduction to Construction Trades
EAST Environmental & Spatial Technology (HS only)
Health Careers Certification Long Term Care/Home Health Care Assistant (HS only)
Heating, Ventilation, & Air Conditioning Residential HVAC Technician
Service Careers SC Custodial, Landscape, & Horticulture Mgmt. (HS only)
Welding Combination Welder (NCCER Aligned)
NAME
SCHOOL
INTEREST INVENTORY
INTEREST SURVEY Circle the items in each box that best describe you. You may make as many or as few circles in each box you choose. Add up
the number of circles in each box. Look to see which row(s) have the highest number.
Co
nst
ruct
ion
Trad
es
OR
He
atin
g
& A
ir O
R S
ervi
ce
Car
eer
s
Activities that describe what I like to do:
Read and follow blueprints and/or instructions. Picture in my mind what a finished product looks
like. Work with my hands. Perform work that requires precise results. Solve technical problems.
Visit and learn from beautiful, historic, or
interesting buildings. Follow logical, step-by-step procedures.
Personal qualities that describe me:
Curious
Good at following directions
Pay attention to detail
Good at visualizing
Patient and persistent
School subjects that I like:
Math
Drafting
Physical Sciences
Construction Trades
Electrical Trades/Heat,
A/C & Refrigeration/
Technology Education
Total number circled this row
Activities that describe what I like to do:
Work under pressure.
Help sick people and animals.
Make decisions based on logic and information.
Participate in health and science classes.
Respond quickly and calmly in emergencies.
Work as a member of a team.
Follow guidelines precisely and meet strict
standards of accuracy.
Personal qualities that describe me:
Compassionate and caring
Good at following directions
Conscientious and careful
Patient
Good listener
School subjects that I like:
Biological Sciences
Chemistry
Math
Language Arts
Occupational Health
Classes
Total number circled this row
HC
C: L
on
g-Te
rm
Car
e/H
om
e H
eal
th
Car
e
Activities that describe what I like to do:
Work with hands and learn best that way. Put things together.
Do routine, organized and accurate work.
Perform activities that produce tangible results.
Apply math to work out solutions.
Use hand and power tools and operate equipment/machinery.
Visualize objects in three dimensions from flat drawings.
Personal qualities that describe me:
Practical
Observant
Physically active
Step-by-step thinker
Coordinated
School subjects that I like:
Math-Geometry
Chemistry
Trade and Industry courses
Physics
Language Arts
Total number circled this row
Co
mb
inat
ion
W
eld
er (
NC
CER
Alig
ne
d)
Activities that describe what I like to do:
Interpret formulas.
Find the answers to questions.
Work in a laboratory.
Figure out how things work and investigate new things.
Explore new technology.
Experiment to find the best way to do something.
Pay attention to details and help things be
precise.
Personal qualities that describe me: Detail oriented
Inquisitive
Objective
Methodical
Mechanically inclined
School subjects that I like: Math
Science
Drafting/Computer- aided Drafting
Electronics/Computer Networking
Technical classes/Technology Education
Total number circled this row
EAST
: Env
iro
nm
enta
l
An
d S
pat
ial
Tech
no
logy
Activities that describe what I like to do:
Travel
See well and have quick reflexes.
Solve mechanical problems.
Design efficient processes.
Anticipate needs and prepare to meet them.
Move things one place to another.
Personal qualities that describe me: Realistic
Mechanical
Coordinated
Observant
Planner
School subjects that I like: Math
Economics
Trade and Industry courses
Physical Sciences
Foreign Language
Total number circled this row
Au
tom
oti
ve
Serv
ice
Tech
nic
ian
(NA
TEF
Co
mp
lian
t)
1st Highest 2nd Highest 3rd Highest
MORE INFORMATION ABOUT EACH ROW:
ICTC-Sallisaw Career Major(s) Description of Career Cluster Career Cluster
*Residential Commercial/Carpenter *Residential HVAC Technician *Service Careers Facilities Maintenance and Landscape Designer
Careers in designing, planning, managing, building, and maintaining the built environment.
ARCHITECTURE & CONSTRUCTION
*LongTerm Care/Home Health Care Assistant (HS Only) *Practical Nursing (Adult Only)
Occupations that require planning, managing, and providing therapeutic services, diagnostic services, health informatics, support services, and biotechnology research and development.
HEALTH SCIENCE
*Welder/Fitter Processing of materials into intermediate or final products and related professional and technical support activities such as production planning and control, maintenance, and manufacturing/process engineering.
MANUFACTURING
*Environmental & Spatial Technology (EAST)
Providing scientific research and professional and technical services (e.g., physical science, social science, engineering), including laboratory and testing services, and research and development services.
SCIENCE, TECHNOLOGY, ENGINEERING, & MATHEMATCIS
*Auto General Service Technician Planning, management, and movement of people, materials, and goods by road, pipeline, air, rail, and water and related professional and technical support services.
TRANSPORTATION, DISTRIBUTION & LOGISTICS
Note: Your interests may change from time-to-time. These survey results are intended to help you with informal career exploration for the career majors that are offered at our school. It does not make any claims of statistical reliability.
OTHER CAREER RESOURCES
ONLINE
WWW.OKCIS.INTOCAREERS.ORG
WWW.OKCOLLEGESTART.ORG
IN PERSON
YOUR HIGH SCHOOL COUNSELOR
CAREER TECH COUNSELOR HIGHER EDUCATION INSTITUTION
ONE-STOP CAREER CENTERS
Indian Capital Technology Center does not discriminate on the basis of race, color, religion, national origin, sex/gender, age, disability, marital or veteran status.