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For LCTI Staff Use Only LCTI Student ID: ___________ Entry Date: ______________ LCTI APPLICATION – 2020-2021 SCHOOL YEAR STUDENT INFORMATION – Please print _____________________________________________________________________________________________________________________ Last Name First Name Middle Birth Date _____________________________________________________________________________________________________________________ Street Address City State Zip Grade in 2020-2021 _____________ PROJECTED GRADUATION YEAR ______________ SENDING SCHOOL (CHECK ONE) ALLENTOWN SCHOOL DISTRICT CATASAUQUA HIGH SCHOOL EMMAUS HIGH SCHOOL L.E. DIERUFF WILLIAM ALLEN BUILDING 21 NORTHERN LEHIGH HIGH SCHOOL NORTHWESTERN LEHIGH HIGH PARKLAND HIGH SCHOOL SCHOOL SALISBURY HIGH SCHOOL SOUTHERN LEHIGH HIGH SCHOOL WHITEHALL HIGH SCHOOL HOME SCHOOLED (Resident District must be checked CENTRAL CATHOLIC OTHER: above) PARENT INFORMATION - Please Print 1st Parent/Guardian Information: DOES STUDENT RESIDE WITH 2nd Parent/Guardian Information: DOES STUDENT RESIDE WITH PRIMARY CONTACT? YES NO (circle one) SECONDARY CONTACT: YES NO (circle one) 1. Name: 2. Name: Father Mother Guardian Other: Father Mother Guardian Other: Home Home Address: Address: Primary *Home ( ) Cell ( ) Primary *Home ( ) Cell ( ) Phone: Phone: 2nd Phone: *Home ( ) Cell ( ) 2nd Phone: *Home ( ) Cell ( ) *By providing this number I give consent for LCTI to place *By providing this number I give consent for LCTI to place auto auto dialed calls to it and will notify LCTI immediately if I do dialed calls to it and will notify LCTI immediately if I do not want not want auto dialed calls to this number or if my number is auto dialed calls to this number or if my number is changed, changed, transferred, or removed. transferred, or removed. Work phone: Work phone: *E-mail Address: *E-mail Address: *AN EMAIL ADDRESS IS VITAL FOR LCTI TO SEND IMPORTANT MESSAGES TO PARENT/GUARDIAN EMERGENCY CONTACT Emergency Contact OTHER THAN Parent(s)/Guardian(s) listed above: DOES STUDENT RESIDE WITH EMERGENCY CONTACT: YES NO Name: Primary 2nd Phone: Phone: Home Cell Home Cell Emergency Contact Relationship to Student: Work Phone: e-mail address Father Mother Guardian Other: Home Address: Page 1 of 4 Directions: Please select the top 6 CTE Programs that interest you and rank them (1-6) in order of your interest. Be sure to place the #1 beside your top choice. For more information about LCTI and its programs, please visit our website at lcti.org. PROGRAM PROGRAM Arts and Humanities Industrial Technology Advertising Design/Commercial (continued) Photography Carpentry Business & Communication Technology IT Academy: Computer & Networking Diesel Medium and Heavy Truck Technology Technology IT Academy: Computer Information Electrical Technology Technology IT Academy: Emerging Digital Media and Heating/Air Conditioning and Social Communications Refrigeration IT Academy: Web Design/Web Heavy Equipment Operations & Programming Preventive Maintenance (Grades 10-12 only) Marketing and Business Education Masonry Print Technology/Graphic Imaging Painting and Decorating Engineering & Advanced Manufacturing Plumbing and Heating Computer Aided Drafting and Design Small Engines/Recreational Vehicle Electromechanical/ Mechatronics Repair Technology Health and Human Services Electronics Technology/Nanofabrication **Criminal Justice Pre-Engineering/Engineering Technology **Dental Technology Precision Machine Tool Technology **Exercise Science and Rehabilitation Services Supply Chain Management & Logistics Commercial Baking Technology Welding Technology Cosmetology Industrial Technology Culinary Arts Auto Body/Collision Repair Technology Early Care & Education of Young Children Auto Technology **HEALTH AND HUMAN SERVICES ACADEMY Cabinetmaking & Millwork Page 2 of 4 PARENT PERMISSION This is to certify that my child/student has my permission to participate in an approved career and technical education program under the authority of the Lehigh & Career and Technical Institute. I agree to provide lab clothing and supplies as required and understand that such items are the personal property of the student, who must be responsible for their safe-keeping. Career & Technical programs may involve operation of power machinery, electrical components, and program specific tools. Safe use of all tools and power equipment and electrical components is taught to the students. Reasonable precautions are taken to avoid accident or injury to the student or others within the instructional area. I understand that there are risks involved in providing career and technical education. I have had the opportunity to review the Essential Skills Alignment Charts for the programs my child/student selected on the application. PARENT’S SIGNATURE: ____________________________________________________ DATE: _____________________________ STUDENT’S STATEMENT OF INTENT (REQUIRED) CEW 13.1.11 Career Awareness and Preparation PLEASE ANSWER THE FOLLOWING QUESTION: How will attending Lehigh Career & Technical Institute prepare you for your career goals? (5 or more sentences) You may continue your essay on separate paper if more space is needed. ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ ____________________________________________________________________________________________________________ STUDENT’S SIGNATURE: ________________________________________________ DATE: _________________________________ STOP UPON COMPLETION OF PAGES 1 – 3 OF THIS APPLICATION, RETURN IT TO YOUR SENDING SCHOOL COUNSELING OFFICE Page 3 of 4 Special Programs **Emerging Health Professionals (EHP) – Senior Level Only The Emerging Health Professionals Program is a partnership of Lehigh Career & Technical Institute, Lehigh Valley Health Network, Penn State University Lehigh Valley, and Lehigh Carbon Community College. This dual enrollment program combines interaction, university level classroom learning, and observation in the health care setting. In addition to completing the written LCTI Application, prerequisite courses and additional information is required for consideration for acceptance into this program. Diversified Career Occupations (DCO) – Grades 11 and 12 only The Diversified Career Occupations Program is offered to qualified students as an alternate method of earning credits toward graduation while gaining valuable workplace experience. The program is delivered through weekly classroom instruction at the sending district high school and work-based experience, along with completion of weekly requirements. The LCTI application, Workplace Training Agreement and additional information is required to enroll students into the program. Entry Date (Official Schedule Change Date for PIMS Reporting) ____________________ Service Occupations Cluster (SOC) The Service Occupation Cluster encompasses several curricular areas designed to help the student transition from basic entry-level skill development to more advanced technical training leading directly to the workforce. The Service Occupations Cluster labs were developed for students who need a small group setting to learn and intense support with math and reading in order to master skill competencies. A skills assessment must be completed prior to applying to this particular program to determine the readiness and interest of each student. Academic Center - Grades 10 through 12 only The Academic Center is a great opportunity for our students in grades 10 through 12 to attend LCTI full day. This means that academic classes and the CTE program are taken all in the same building. All academic courses are college preparatory courses which will prepare the students to be career and college ready. Class sizes are small so that personal attention is given for our students to thrive academically. There is an additional application for the LCTI Academic Center required for consideration of enrolling in the Academic Center. SENDING SCHOOL COUNSELOR STUDENT’S PA SECURE ID NUMBER (REQUIRED) __________________________ INDICATE LCTI SESSION: AM OR PM HALF-DAY STUDENTS ONLY – Courses offered according to school agreement _____ American Studies II _____ No Academic Classes Needed _____ Wellness and Fitness _____ Request Senior Recovery Courses (Must be discussed and approved by LCTI Counselor) The student demographic information provided within this application will not be used for enrollment purposes. This information is for Pennsylvania Department of Education and LCTI demographic reporting purposes, and planning for required student services among the nine sending school districts. IEP: Yes No ELL: Yes No If yes, case manager

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