Bristol-Plymouth Regional Technical School Admissions Application 207 Hart Street, Taunton, MA 02780 Phone: 508-823-5151 ext. 115/ Fax: 774-299-6355

Name______Last First Full Middle

Date of Birth ______/______/______Application for Grade (circle one) 9 10 11 12

Street Address______City/Town______

State______Zip ______Parent Email Address ______

Mailing Address if different:______

Telephone # (______)______Cell phone # (______)______

Parent/Guardian: ______

School Currently Attending* ______Present Grade______*Please indicate technical program if applying to transfer from another Chapter 74 state-approved vocational technical education program. ______

SIGNATURE SECTION

All applications must be signed by a parent or guardian and student.

By signing below I affirm that the information furnished on the application form is complete and accurate. I also give permission for the sending school to release the applicant’s records including grades, attendance, and conduct/discipline records. In order for this application to be processed the applicant must complete an interview. Please visit our website www.bptech.org for more information regarding the interview process.

Signature of Student ______Date______

Signature of Parent/Guardian______Date______

Return completed application to:

Karen L. Barrar, Pupil Services Administrator Bristol-Plymouth Regional Technical School 207 Hart Street Taunton, MA 02780 Telephone: (508) 823-5151, ext. 115 Page 1 of 2 Fax: (774) 299-6355 VOLUNTARY INFORMATION SECTION

The information in this section is not required for admission. Submission of the information is entirely voluntary. Information submitted voluntarily by the applicant will not affect the applicant’s admission to the school. The information, if supplied, will be used for monitoring equal educational opportunity in the school district. In addition, note that applicants with disabilities may voluntarily self-identify for the purpose of requesting reasonable accommodations during the entire application and admission process. Applicants who are English language learners or limited English proficient may voluntarily self-identify for the purpose of receiving interpretive services during the entire application and admission process.

1. Are you receiving special education services? Yes ___ No ___ If yes, do you need accommodations during the application process? Yes ___ No ___ If yes, the district will provide someone to assist you.

2. Are you receiving services under a 504-Accommodation plan? Yes ___ No ___ If yes, do you need accommodations during the application process? Yes ___ No ___ If yes, the district will provide someone to assist you.

3. Applicant is an English language learner or limited English proficient? Yes ___ No ___

4. Language spoken at home? ______Do you need language assistance during the application process? Yes ___ No ___ If yes, do you need accommodations during the application process? Yes ___ No ___ If yes, the district will provide someone to assist you.

5. Gender: Female ____ Male ____

 Bristol-Plymouth Regional Technical School is accredited by the New England Association of Schools and Colleges.  Each Bristol-Plymouth graduate receives a High School Diploma and a Vocational Certificate of Competence.  Since final shop placement of students is based on the Exploratory Program and space availability, we can not guarantee that the final shop placement will be the applicant’s first choice.  Bristol-Plymouth services students within the Bristol-Plymouth Regional School District and includes as part of its region, the towns of Berkley, Bridgewater, Dighton, Middleboro, Raynham, Rehoboth and the City of Taunton.  A copy of the Bristol-Plymouth Regional Technical School Admissions Policy is available on the school’s website: www.bptech.org, or by contacting the Student Services Department.  Acceptance and enrollment at Bristol-Plymouth Regional Technical School is conditioned upon the accuracy and completeness of a student’s application. Bristol-Plymouth Regional Technical School reserves the right to revoke its conditional acceptance of any student, at any time, if it determines that the student, the student’s parent(s)/guardian(s), or the student’s sending school district intentionally provided inaccurate, incomplete, or misleading information during the application process.

Bristol-Plymouth Regional Technical School strives to provide a safe, respectful, and supportive learning environment in which all students can thrive and succeed in school. Bristol-Plymouth Regional Technical School prohibits discrimination on the basis of race, color, sex, gender identity, religion, national origin, sexual orientation, disability, or homelessness status and ensures that all students have equal rights of access and equal enjoyment of the opportunities, advantages, privileges and courses of study.

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