LCTI APPLICATION FOR THE ACADEMIC CENTER ONLY For LCTI Staff Use Only LCTI Student ID: ___________ Entry Date: ______________ You must be enrolled in a career & technical education half day program at LCTI in order to apply to the LCTI Academic Center. The LCTI Academic Center is opened to students in grades 10-12 from our 9 sending school districts. INSTRUCTIONS: PLEASE COMPLETE THE FOLLOWING INFORMATION STUDENT INFORMATION – Please print ___________________________________________________________________________________________________________________ Last Name First Name Middle Birth Date ___________________________________________________________________________________________________________________ Street Address City State Zip SENDING SCHOOL (CHECK ONE) ALLENTOWN SCHOOL DISTRICT CATASAUQUA HIGH SCHOOL EMMAUS HIGH SCHOOL L.E. DIERUFF WILLIAM ALLEN NORTHERN LEHIGH HIGH SCHOOL NORTHWESTERN LEHIGH HIGH SCHOOL PARKLAND HIGH SCHOOL SALISBURY HIGH SCHOOL SOUTHERN LEHIGH HIGH SCHOOL WHITEHALL HIGH SCHOOL OTHER: PARENT/GUARDIAN INFORMATION - Please Print NAME: RELATIONSHIP TO STUDENT: HOME ADDRESS: PRIMARY PHONE: HOME: CELL: I, as parent or guardian of the student who has completed the above, give permission for my son/daughter to apply for admission into the LCTI Academic Center. ________________________________________________ _________________________________________________ Parent/Guardian Signature Date Check one of the following: Current LCTI Student ___________________________________________ LCTI Program New LCTI Student Submit the LCTI Academic Center Application and the LCTI Application ________________________________________________________ ______________________________________________ Student Signature Date School Counselor Due to accountability measures, all applications are required to be signed by a sending school counselor in order to be processed. Please print and sign your name below. _______________________________ _____________________________________ __________________________ COUNSELOR PRINTED NAME SIGNATURE DATE Page 1 of 2 LCTI Academic Center Application Academic Center Courses Only – To be completed by Sending School Counselor. Attach: Transcript Attendance Discipline 11th Grade Course th 10 Grade Course English Language Arts – Select only one English Language Arts II – All Students _____ English Language Arts III American Studies II – All Students _____ Accelerated/Dual Enrollment English Language th Arts III (Requires “B” or higher in 10 grade ELA and Math – Select only one placement test score) _____ Algebra II _____ Geometry (Prerequisite – *World Cultures – All Students Algebra II) Math – Select only one Science – Select only one _____ Algebra II _____ Biology _____ Geometry (Prerequisite – _____ Chemistry Algebra II) _____ Pre-Calculus Science – Select only one _____ Biology th 12 Grade Course _____ Chemistry _____ Physics I (Must have completed or be enrolled in Algebra II) English Language Arts – Select only one _____ Environmental Science _____ English Language Arts IV _____ Accelerated English Arts IV *Wellness & Fitness – All Students th (Requires “B” or higher in 11 grade ELA) *Semester Course Select either one Math or Science _____ Algebra II _____ Geometry _____ Pre-Calculus _____ Calculus _____ Biology _____ Chemistry _____ Environmental Science _____ Physics I (Must have completed or be enrolled in Algebra II) Social Studies – Select only one _____ Economics/Government/Civics _____ Accelerated Economics/Government/ Civics th (Requires “B” or higher in 11 grade Social Studies) Wellness & Fitness – All students – Full year Page 2 of 2 Lehigh Career & Technical Institute has a policy not to discriminate on the basis of race, color, national origin, sex, disability, or age in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. Inquiries may be directed to LCTI’s Title IX and Section 504 Coordinator for students at 4500 Education Park Drive, Schnecksville PA, 18078 or 610-799-1357 or LCTI’s Compliance Officer for personnel at 610-799-1385. Form 067A rev. 11/2019 .