<p>Career and Technical Education Enrollment Reporting System (CTEERS) Composite Enrollment Report--Sample Student Data Collection Form (REVISED 4/26/10) Note: #1-16 are to be completed for ALL students 1. District Number 2. School Number: 3. Student’s District of Residence:</p><p>4. Student Number: 5. Grade: 6. Last Name: 7. First Name:</p><p>11 12 13</p><p>8. Date of Birth: 9. Gender:</p><p>M = Male F = Female</p><p>10. Race(s): 11. Characteristic(s):</p><p>A = Asian H = Handicapped B = Black / African American L = Limited English Proficient H = Hispanic A = Disadvantaged -- Academic I = American Indian / Alaska Native E = Disadvantaged -- Economic P = Pacific Islander / Hawaiian R = Regular W = White</p><p>12. Teen Single Parent: 13. Student Progress (sufficient credits received):</p><p>Y = Yes N = No Y = Yes N = No</p><p>14. Career Plan (written plan on file): 15. Post-High School Career Preparation:</p><p>Y = Yes N = No 1 = Non-Baccalaureate Prep 2 = Baccalaureate Prep 3 = Career Prep 4 = Undeclared</p><p>16. CTE Participant (enrolled in at least one CTE course this year OR has completed three or more CTE courses within their chosen pathway OR participated in #26 Advanced Standing, #28 Tech College Transcripted Credit or #30 Youth Apprenticeship that involved CTE coursework):</p><p>Y = Yes N = No</p><p>Note: If #16 = Yes, fill in #17-22, otherwise skip to #23. 17. Program Area(s) Participation:</p><p>A = Agriculture and Natural Resources B = Business and Information Technology Education F = Family and Consumer Science Education H = Health Science Education M = Marketing Education T = Technology and Engineering Education</p><p>18. CTE Concentrator (completed at least two CTE courses AND is enrolled in a third CTE course this year that is within the student’s chosen pathway OR has completed three or more CTE courses within their chosen pathway):</p><p>1 = Is a CTE Concentrator and is enrolled in operational Program of Study (POS) at the district 2 = Is a CTE Concentrator and is not enrolled in an operational Program of Study (POS) at the district N = Is not a CTE concentrator</p><p>Note: If #18 = Yes, fill in #19-22, otherwise skip to #23. Career and Technical Education Enrollment Reporting System (CTEERS) Composite Enrollment Report--Sample Student Data Collection Form (REVISED 4/26/10) 19. Instructional Area Code (for CTE Concentrator’s focus—4-digit code from manual):</p><p>20. Non-Certificated Learning 21. Certificated Learning Methodology Code(s): Methodology Code(s): 1 = Youth Apprenticeship Program 1 = Co-op 2 = State Certified Co-op 2 = Supervised (by teacher) 3 = Employability Skills 3 = Simulation (in class) 4 = Business/Industry Sponsored Certificate 4 = Internship 5 = None at this time (skip to #23) 5 = Other (describe) 6 = None at this time</p><p>22. Certificated Learning Completion Code(s):</p><p>1 = Met requirements and was or is to be awarded certificate 2 = Is continuing in certificated program 3 = Left certificated program before completion 4 = Completed program but did not meet requirements for certificate</p><p>Note: #23-33 are to be completed for ALL students 23. Completion Status:</p><p>C1 = Is a CTE Concentrator and will graduate this year DI = Will graduate this year but is not a CTE Concentrator D2 = Dropped out of school this year D3 = Died this year B1 = Transferred to another district this year A1 = Is continuing secondary studies</p><p>24. Compulsory School Attendance: 25. Youth Options Attendance:</p><p>___ = tech college code ______= tech college or university code(s) X = Not participating X = Not participating</p><p>Note: #26-31, if student participated in any of these agreements this year that involved CTE coursework, that student should be coded as a CTE education participant—complete #16-22. 26. Advanced Standing--enrolled and 27. Advanced Standing—completed for credit: participated:</p><p>______= tech college code(s) ______Y = Yes or N = No X = Not participating X = Not participating</p><p>28. Tech College Transcripted Credit—enrolled 29. Tech College Transcripted Credit—completed for and participated: credit:</p><p>______= tech college code(s) ______Y = Yes or N = No X = Not participating X = Not participating</p><p>30. Youth Apprenticeship—participated for 31. Youth Apprenticeship—completed for credit: articulated credit or advanced standing:</p><p>______= tech college or university code(s) ______Y = Yes or N = No X = Not participating X = Not participating</p><p>32. University Transcripted/Dual Credit— 33. University Transcripted/Dual Credit—completed: Career and Technical Education Enrollment Reporting System (CTEERS) Composite Enrollment Report--Sample Student Data Collection Form (REVISED 4/26/10) enrolled and participated:</p><p>______= university code(s) ______Y = Yes or N = No X= Not participating X = Not participating</p><p>Tech College Codes (2-character alpha): BH = Blackhawk MW = MATC-Milwaukee NE = Northeast WI CV = Chippewa Valley MS = Midstate SW = Southwest WI FV = Fox Valley MP = Moraine Park WC = Waukesha Cty GW = Gateway NI = Nicolet Area WW = Western WI LS = Lakeshore NC = North Central WI = WI Indianhead MA = MATC-Madison</p><p>University Codes (4-digit number): 4657 = UW-Baraboo 4696 = UW-Marathon 4678 = UW-River Falls 4653 = UW-Barron 4693 = UW-Marinette 4689 = UW-Rock Co 4670 = UW-Eau Claire 4697 = UW-Marshfield 4695 = UW-Sheboygan 4673 = UW-Fond du Lac 4681 = UW-Medford 4680 = UW-Stevens Point 4687 = UW-Fox Valley 4658 = UW-Milwaukee 4652 = UW-Stout 4688 = UW-Green Bay 4674 = UW-Oshkosh 4682 = UW-Superior 9000 = UW-Kenosha 4690 = UW-Parkside 4659 = UW-Washington Co 4672 = UW-LaCrosse 4676 = UW-Platteville 4698 = UW-Waukesha 4656 = UW-Madison 9921 = UW-Racine 4684 = UW-Whitewater 4692 = UW-Manitowoc 4634 = UW-Richland</p><p>Other College Codes:</p><p>University Codes (4-digit number): 1000 = college level advanced placement course taught at the high school</p><p>Tech College Codes (2-character alpha): IA = technical college of attendance or articulation agreement with a technical college or university located in Iowa IL = technical college of attendance or articulation agreement with a technical college or university located in Illinois MI = technical college of attendance or articulation agreement with a technical college or university located in Michigan MN = technical college of attendance or articulation agreement with a technical college or university located in Minnesota OT = technical college of attendance or articulation agreement with a private technical school or college WS = technical college of attendance or articulation agreement with a private technical school or college</p>