P.O. Box 1599, Liberal, Kansas 67905-1599
Application for Admission
General Directions: Return this application and a non-refundable student activity fee of $200.00 to Southwest Kansas Technical School. Please have a copy of your high school transcript or G.E.D. certificate sent to SWKTS. After you finish filling out all of the following information, please print it and mail it to:
SWKTS Registrar
2215 N. Kansas Ave
PO Box 1599
Liberal, KS 67905-1599
Date you plan to enter: Today's Date:
SWKTS Program in which you are enrolling: Air Conditioning\Refrigeration Auto Body\Collision Repair Automotive Parts Management Auto I (HS) Auto II Brick Masonry Communications Technology Diesel Technology Drafting Technology Machine Tool Technology Medical Assistant Microprocessor Technology Office Occupations Welding Technology
Legal Name: Last First Middle Maiden
SSN: Telephone: Birth Date:
Place an "x" in the box that applies
Marital Status: Single Married Divorced Widowed Your Title: Mr. Miss Ms. Mrs.
Number of legal dependents (other than spouse) under age 18
Ethnic Origin: (I consider myself) White Black Hispanic American Indian Asian Other
MY ADDRESS IS: State both and place an "X" in the box where mail should be sent.
Home: Street or Box City State Zip
Kansas: Street or Box City State Zip
Name of Spouse Parent or Guardian
Their Address: Street or Box City State Zip
Emergency Telephone No.
MY EDUCATION:
High School Attended:
Name City State Highest Grade Completed Year Graduated
Vocational School Attended:
Name City State Course of Study
College Attended:
If you did not graduate from High School, do you have a G.E.D.? Yes No
MY MEDICAL HISTORY:
Do you have a physical or mental condition(s) an instructor should be aware of? Yes No If yes, Explain
Are you presently under a doctor's care? Yes No If yes, Explain
You MUST provide proof of having had a Tuberculosis Test in the last 12 months.
Applicants Signature:
CERTIFICATION OF EMPLOYMENT OBJECTIVE AND PURPOSE OF TRAINING
Are you a U.S. Citizen? Yes No
If no, are you an eligible non-citizen? Yes No
If you are an eligible non-citizen, please check below the Alien Registration Card issued to you.
I-94 I-151 I-551 I-688
My purpose for enrolling in the program is to prepare myself for employment as a
Drivers' License Number:
This will certify that I will upon my completion in training, accept employment in the above named occupation if such employment is available
Today's Date Signature of Student
SOUTHWEST KANSAS TECHNICAL SCHOOL DRUG PREVENTION PROGRAM
July1,2001-- June 30,2003
In compliance with:
The Drug Free Schools and Communitites Act Amendments of 1989, Public Law 101-226.
The Drug and Alcohol Policy of Southwest Kansas Technical School is intended to assure a drug and alcohol free environment on our campus and at any school activity. To achieve the goal of a drug free school, the ensuing program shall be followed:
A. The annual distribution of writing to each student regardless of the length of the student's program of study and to each employee the following information:
1. Standards of Conduct:
No person shall be involved in the unlawful possession, use or distribution of illegal drugs or alcohol, whether that person
be a student or employee of the Southwest Kansas Technical School, while on school property or at any school activity
Further, no student or employee shall attend school or any school activity while under the influence of any illegal drug
or alcohol.
Any student or employee of Southwest Kansas Technical School convicted of possession, use or distribution of illegal
drugs shall not be permitted to attend Southwest Kansas Technical School or any school activity until that person is
deemed to be rehabilitated by an appropriate treatment.
2. Local, State and Federal legal sanctions:
The possesion, use or distribution of illicit drugs and alcohol is illegeal and is punishable by fines, imprisonment or both.
3. Health Risks:
The use of illicit drugs or alcohol is harmful to the physical and mental health as well as exposes the user to increased risk
of accident. This use can lead to permanent illness or death, cause permanent brain damage and endanger others
because of the user's lack of coordination and impaired judgment.
DRUG AND ALCOHOL PREVENTION POLICY
I certify that I have received a copy of the Drug and Alcohol Prevention Policy of Southwest Kansas Technical School
Today's Date: Signature of Student:
RESIDENT STATUS
I understand that I must be a permanent resident of the state of Kansas. To be a Kansan I must be 18 years of age.
1. Will you be 18 years of age by the first day of school? Yes No
A. If "No" my state of legal residence is the same as my parent or legal guardian which is:
State in which parent or legal guardian live:
B. If "Yes" give date in which you made residence in Kansas. Date
2. I intend to make Kansas my permanent residence now or on my 18th birthday.
STUDENT INSURANCE INFORMATION
If you are covered by Health/Accident Insurance, please complete the following:
Name of Insurance Company
Address
Policy Number
Southwest Kanas Technical School does not discriminate on the basis of sex, race, color, national origin, or handicap in the educational programs or activities which it operates.
REQUEST FOR SCHOOL RECORDS AND TEST SCORES
Date:. I hereby authorize School District , Name of High School, City State Zip , to send of copy of the records of Student's Name, Date of Birth , Graduation or Attendance Date ,
Student's Signature of Parent's or Guardian's Signature
Please forward a copy of the Student's school records and test scores to:
Director of Admissions
Southwest Kansas Technical School
P.O. Box 1599
Thank you for your attention to this matter.
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