2016‐2017 School Year Enrollment Request 4141 N. Regal, Spokane, WA 99207 (509) 354‐7470 FAX: (509) 354‐7474 www.SkillsCenter.com Complete this form and return it to your school counselor for processing. Last Name ________________________________________ First Name _________________________________ MI _________ Mailing Address ______________________________________________________________________________________________ City ________________________________________________ State _________ Zip ___________ Current Grade Level ________ Home Phone ( ) ________________ Email: ___________________________________________ Birthdate _____ / _____ / ____ (Parent / Guardian Preferred) High School _____________________________________________________________________________ Gender _____________ Parent / Guardian Name(s) ______________________________________________________________________________________ Ethnic / Racial Group: (Select one) Caucasian American Indian Black / African American Pacific Islander Hispanic Asian Biracial Class Selection: Choose AM or PM and indicate your 1st and 2nd choice. Animal Science & Veterinary Careers Dental Careers  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Animation Technology & Special Effects Digital Game & Web Design  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Automotive Technology Graphic Design & Digital Arts  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Biomedical Applications (PLTW) Industrial Manufacturing & Engineering (NEW!)  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Collision Repair Medical Assisting  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Construction Technology Medical Careers / NAC  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Cosmetology Mobile Electronics  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Criminal Justice Robotics & Engineering  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Culinary Arts & Hospitality Management Welding Technology  AM  PM  1st Choice  2nd Choice  AM  PM  1st Choice  2nd Choice Cyber Security  AM  PM  1st Choice  2nd Choice  I am a CURRENT / FORMER NEWTECH STUDENT Media Release By registering to attend NEWTECH Skill Center, I understand, voluntarily acknowledge and assume the specific risk that my student’s picture, name and/or statements may appear in the media, public relations materials and/or on the internet (e.g. website). If you DO NOT give permission for your student to be photographed and/or interviewed by school staff, district or media representatives, please fill out the Media Opt Out Form which may be requested from our office. School Counselor: Please check all that apply Special Education / 504 / ELD Students
 Yes No Health conditions affecting education needs  Yes  No Special Education Referral Form attached  Yes  No Past, current, or pending disciplinary action  Yes  No IEP (copy attached)  Yes  No History of violent behavior  Yes  No 504 (copy attached) *Please attach a copy of the student’s transcript  Yes  No ELD / ELL *If student has an emergency health care plan, it must be attached to this registration Please explain “Yes” answers: ________________________________________________________________________________ Counselor’s Signature ______________________________________________________ Date _________________________ Spokane Public Schools complies with all federal and state rules and regulations and does not discriminate on the basis of age, sex, marital status, race, color, creed, national
origin, the presence of any sensory, mental, or physical disability, or the use of a trained dog guide or service animal by a person with a disability, sexual orientation including
gender expression or gender identity, or honorably discharged veteran or military status. This holds true for all students who are interested in participating in educational
programs and/or extracurricular school activities, and provides equal access to the Boy Scouts and other designated youth groups. Inquiries regarding compliance and/or
grievance procedures may be directed to the school district’s Title IX officer and/or Section 504/ADA coordinator. Title IX Officer, Steven Gering (509)354-7396, Section
504 Coordinator, Wendy Bleecker (509)354-7248, ADA Officer, Tennille Jeffries-Simmons (509)354-7265, Affirmative Action Officer, Angela Jones (509)354-5961, Equal
Opportunity Officer, Ramon Alvarez (509)354-7344, 200 N Bernard Street, Spokane, WA 99201