CHOICE Application2012 by qiF57a


									                                               Career and Technical Education                                                    For school use
                                                                 CTE - CHOICE                                                    Application No:
                                                                                                                                 Date Received:
                                                     Application for SY 2012-13

Student Information: Please Print
 Please Print
Student Last Name                                                                First Name                                                            MI
Student Number                                                                    Date of Birth                                                 Male           Female
Parent/Guardian Names
Street Address
City                                                Zip                          Hm. Phone                                         Work/Cell
Current Grade Level                              Grade for 2012-13                             Current school attending

                                                                                                                                                                    Out-of Area
High School requested: MERRITT ISLAND HIGH SCHOOL                                                                                                                    Transfer X
Career & Technical Program requested: (check one) FAME Academy __ da Vinci Academy of Aerospace Technology
CTE-CHOICE Course(s) requested for entire school year 2012-13 (check one):
          FAME: Fame English, Fame Social Studies, FAME elective ____
          da Vinci: da Vinci English, da Vinci Science, da Vinci Engineering elective ___
 Academic Course(s) will also be requested at CTE-CHOICE school site? Yes X

Please answer the following questions:
    What is your current state unweighted cumulative GPA?                                    N/A
    Would you require school district transportation to attend?                                 No X
    How did you learn about the CTE-CHOICE program?

    Applications must be received by the requested high school through mail or delivered by 4:00 p.m. on
       February 3, 2011.
    Student selection will be by lottery to be held on February 15, 2012 at 3 pm at MIHS.
    Student attendance, academic performance, and conduct will be considered by the school principal(s) for initial
     approval and continued enrollment in a CTE-CHOICE program.

The approval of a student to attend a school other than his/her zoned school of attendance for the purpose of
attending a choice school or program is valid for as long as the student participates in the choice school/program.
A student must return to his/her zoned school of attendance at the end of the semester if he/she no longer
participates in the choice school or program.

                                                              Date                            It is the parent/student responsibility to make sure
Parent/Guardian                                                                               the requested high school has received the
                                                                                              application by the deadline.
Student Signature

                                                                             NON-DISCRIMINATION NOTICE
 It is the policy of the School Board of Brevard County to offer the opportunity to all students to participate in appropriate programs and activities without regard to race, color,
 gender, religion, national origin, disability, marital status, or age, except as otherwise provided by Federal law or by Florida state law.
                                                           A student having a grievance concerning discrimination may contact:
 Dr. Brian T. Binggeli, Superintendent, Ms. Brenda Blackburn, Associate Superintendent, Dr. Walt Christy, Director Secondary Education, or Ms. Eva Lewis Director ESE
 Program Support Services. School Board of Brevard County, 2700 Judge Fran Jamieson Way, Viera, FL 32940-6601 (321) 633-1000

    Faxed applications will not be accepted.                                                                              This form is for information purposes only.
11/5/09                                                                                Page 1 of 1

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