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Workforce Ready Application
Application for Admission
PART 1. PROGRAM PREFERENCE
☐ I am applying for the Basic Auto Mechanic & Detailing Assistant program.
☐ I am applying for the Landscape Gardening Assistant program.
☐ I am applying for the Food Services Assistant program.
PART 2. STUDENT INFORMATION
NAME: [PRINT]______________________________________________________
ADDRESS:___________________________________________________________
___________________________________________________________________
PHONE: (___) _______________________________________________________
CELL PHONE: (___) ___________________________________________________
EMAIL ADDRESS: ____________________________________________________
SOCIAL SECURITY NUMBER: ____________-_______-_____________
DATE OF BIRTH: _____________________________________ AGE: _________
month
GENDER:
day
⛘male
year
⛘female
WILL YOU BE AT LEAST 18 YEARS OLD BY THE PROGRAM STARTING DATE? ⛘ Yes ⛘ No
RACE: ⛘ White ⛘African-American
⛘Native American
DO YOU HAVE A DRIVER’S LICENSE?
⛘ Yes
⛘Hispanic
⛘Asian
⛘Other
⛘ No
HAVE YOU COMPLETED HIGH SCHOOL? Read all the answers and then check the
most correct answer.
⛘ Yes, I received my diploma in (month & year) _________________________________.
⛘ Yes, I received my “Graduation Certificate” (formerly Certificate of Achievement) in (month
& year) ________________________________.
⛘ No. My highest grade completed was grade ___________ in (month & year) _____________.
WHAT WAS THE LAST HIGH SCHOOL YOU ATTENDED?
School Name: __________________________________________________________________
City: ___________________________________________________ State: _________________
PART 3. STUDENT RECORDS
TRANSCRIPTS:
Students are responsible for contacting their previous high school and
requesting a sealed, official copy of their high school transcript.
TABE ASSESSMENT: (Test of Adult Basic Education): Students are responsible for
contacting Ginny Navarro at (828) 726-2275 to schedule the TABE.
DISABILITY SERVICES: Students who require disability services or reasonable
accommodations must identify themselves as having a disability and provide current diagnostic
documentation to the Disability Services Office located in the F Building, Room 108. For more
information please contact Tuesday Sigmon, Counselor/Coordinator of Disability Services (828)
726-2716 or email at [email protected] for the Caldwell Campus and Nancy Leonard, Director
of Disability Services at (828) 297-2185 or email [email protected] for the Watauga Campus.
PART 4. FINANCIAL ASSISTANCE
Financial Assistance may be available for the cost of Workforce Ready. Applicants must submit
a written statement explaining his/her financial needs. This statement must be submitted with
the application packet.
PART 5. SCHOOL/AGENCY REFERENCES
A Workforce Ready Reference Form is to be completed by two referring agencies (examples:
School System and Vocational Rehabilitation). Each agency representative will complete the
Reference Form, seal it, and give it to the student to include with this Application for Admission.
Each reference must be someone familiar with the student’s skills and work habits.
PART 6. COMMUNITY SUPPORTS OR SERVICES
Listed below is a list of community supports or services. Please check the ones
that apply to you:
⛘ Division of Developmental Disabilities
⛘ Division of Vocational Rehabilitation (VR)
⛘ Medicaid Waiver
⛘ Social Security Disability Insurance
⛘ Supplemental Security Income
⛘Other: __________________________________________________
PART 7. CURRENT EMPLOYMENT INFORMATION
[Leave this section blank if currently unemployed]
EMPLOYER: __________________________________________________________________
Please check one that applies to you:
⛘ VOLUNTEER WORK
⛘ PAID EMPLOYMENT
DIRECT SUPERVISOR: ________________________________________________________
WORK PHONE: (___)_________________________________
WORK DAYS HOURS: ____________________START DATE (Month & Year):___________
RATE OF PAY: _____________________________________________
NUMBER OF HOURS: _______________________________________________
PART 8. PERSON TO CONTACT IN CASE OF AN EMERGENCY
NAME: ________________________________________________________________________
RELATIONSHIP: _________________________________________________________________
HOME PHONE: _________________________________________________________________
WORK PHONE: _________________________________________________________________
CELL PHONE: ___________________________________________________________________
MAY WE DISCUSS YOUR INFORMATION WITH THIS PERSON?
⛘ Yes (if yes, put your initials here:) _______________________
⛘ No
APPLICANT’S SIGNATURE
[Please read and sign below]
By completing and submitting this application, I agree to the policies and procedures of
Caldwell Community College and Technical Institute. I understand my failure to provide
complete, accurate and truthful information on this application may be grounds for refusal of
admission at Caldwell Community College and Technical Institute and the Workforce Ready
program.
Student’s Signature: ___________________________Date___________________
Workforce Ready Information
What is Workforce Ready?
Workforce Ready is a one-year job training certificate program. This entry-level
program provides a foundation for transitioning into a career or additional
coursework. The students further develop reading, math, and computer skills
along with participation in a hands-on practicum experience within a specific
program of study. Adults with intellectual or developmental disabilities are
strongly encouraged to apply.
Who may enroll in Workforce Ready?
Students have been referred by:
•
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High school Exceptional Children’s teachers
Transition Coordinators
Vocational Rehabilitation Counselors
OE Enterprises
Academic Advisors
Guidance Counselors
Academic & Career Ready Instructors
Social Workers/Case Managers
All students must be at least 18 years old.
What Programs are Available?
• Basic Auto & Detailing Assistant
• Landscape Gardening Assistant
• Food Services Assistant
What about Reading, Math and Computer Skills?
• Basic Skills
• Job Exploration and Job Skills
When is Workforce Ready Offered?
• Begins in August and ends in May
What about the hands-on experience?
• Basic Auto & Detailing Assistant students use CCCTI’s automotive facilities.
• Landscape/Gardening Assistants students use CCCTI’s Horticulture
facilities and grounds.
• Food Services Assistant us CCCTI’s facilities on campus.
Where is Workforce Ready Located?
• Caldwell Community College and Technical Institute
Who is responsible for Applying?
• THE STUDENT
What is the Application Process?
• Complete Application Packet & Submit by Deadline
-Application
-Complete the Statement of Interest
-Official High School Transcript
-Reference forms (2)
-Copy of Psychological Evaluation (most current) & IEP
-Take the TABE test (reading and math)
-Sign Expectations and Code of conduct Statement
-Consent for Release of Confidential Information if applicable
Does Workforce Ready Cost?
• Yes. The current cost is $181. Tuition is due before classes start.
• Supplies: textbook, pencils, paper, notebook, other items specified by the
course instructor
Does CCCTI provide transportation?
o No, the student is responsible for transportation.
Questions about Workforce Ready
o Contact:
Ginny Navarro, Coordinator of Special Population
(828) 726-2275
[email protected]
Workforce Ready
2016-2017
Student Application Pack
Application Packet Due Date:
Friday, July 15, 2016
Application Checklist
Please submit the following items:
⛘ A Completed Application
⛘ Official High School Transcript (sealed envelope copy)
⛘ Student Statement of Interest
⛘ Reference Form (need to submit 2 references)
⛘ TABE Test Card (contact Ginny Navarro 828-726-2275 to schedule)
⛘ Copy of Psychological Evaluation (most current) and IEP
⛘ Signed Expectations and Code of Conduct form
⛘ Consent for Release of confidential Information if applicable
Application packets are due to Ginny Navarro, Coordinator of Special Populations. Ms.
Navarro’s office is located in G Building, Room 204. The mailing address is CCCTI, Attention
Ginny Navarro, 2855 Hickory Blvd SE, Hudson, NC 28638.
We will review application packets in July and notify students via phone and/or mail regarding
your admission status to Workforce Ready. The cost of Workforce Ready classes for each
semester is $181 and must be paid to the Continuing Education Department before attending
class. A student will not be permitted to attend Workforce Ready until payment is received.
There may be other cost associated with the class for textbooks and equipment. Scholarships
may be applied for at NC Works and with the Ed Foundation.
If you have any questions please contact me at (828) 726-2275 or email at [email protected].
Regards,
Ginny Navarro
Coordinator of Special Populations
STUDENT STATEMENT OF INTEREST
Please complete the following questions. Feel free to use the back of this form,
type it or use additional paper.
Question # 1
Why are you interested in the Basic Auto Mechanics & Detailing Assistant, Food
Services Assistant, or Landscape Gardening Assistant pathway?
Question # 2
What skills, knowledge, and/or experience do you have with the program area
you have selected on your application?
Question # 3
What are your plans after Workforce Ready?
WORKFORCE READY
Reference Form
Student _______________________________________________________________________
The above named student is applying for the Workforce Ready program at Caldwell Community
College and Technical Institute. In Workforce Ready, enrollees will receive job-specific training,
learn employability skills, and improve basic academic skills. The program is designed for
individuals with intellectual/developmental disabilities and others who are referred by high
schools and appropriate agencies such as Vocational Rehabilitation, Adult Basic Education,
English Language Acquisition and Continuing Education.
Your input and candor in completing this referral form will be appreciated. Carefully answer
each question. When finished, return this form to the applicant in a sealed envelope with your
signature over the sealed closure. He or she will in turn forward your sealed reference form to
us with the completed application packet. Thank you in advance for your assistance.
If you have questions about the program or process, please contact Ginny Navarro, Coordinator
of Special Populations at (828) 726-2275.
Referral Agency ________________________________________________________________
[School system, Voc Rehab, Continuing Education, employer, other]
Agency Contact Person ______________________________________Date_________________
Work Phone (___) ___________________________Cell Phone (___)______________________
How long have you known the applicant? ____________________________________________
What is or was your relationship with this applicant? ___________________________________
______________________________________________________________________________
Please use the rating scale on the next page.
1
Answer the following questions using the rating scale and circling your choice
1.
2.
The applicant reports to the school or job site as scheduled.
The applicant is dependable to do what is asked in a timely
manner.
3.
The applicant is able to follow oral directions.
4.
The applicant is able to follow multi-step directions.
5.
The applicant is able to follow written directions.
6.
The applicant is able to cooperate with others.
7.
The applicant demonstates the ability to be flexible in various
situations.
Not
Observed
Always 5 Mostly 4 Sometimes 3 Rarely 2 Never 1
Not
Observed
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Observed
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Observed
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8.
The applicant has good overall communication skills.
9.
The applicant accepts constructive criticism in an appropriate
manner.
Not
Observed
10.
The applicant is able to use constructive criticism to
improve/change work methods.
5
4
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2
1
Not
Observed
11.
The applicant is able to work independently.
5
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Not
Observed
12.
The applicant displays a willingness to initiate tasks.
5
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Observed
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13.
The applicant maintains good relationships with others.
14.
The applicant maintains appropriate hygiene and appearance.
15.
The applicant demonstrates the appropriate behavior/attitude
at the school or on the job.
Please use the space below, the back of the page, or additional paper for additional comments
or information. Refer to the numbered questions above as needed.
Caldwell Community College and Technical Institute
Workforce Ready
TABE Assessment Card
Call 828-726-2275 for TABE assessment appointment
Student Name ________________________________________________
Test Date ______________________________________________
Reading Score and Test Version _________________________________
Math Score and Test Version ____________________________________
Assessment Technician Signature _________________________________
WORKFORCE READY EXPECTATIONS AND CODE OF CONDUCT
Our expectations are that, as adults, you will act in a courteous and considerate manner toward
other students, faculty, and staff. What does “courteous and considerate” mean? A courteous,
considerate person will:
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Attend class as scheduled and be on time for class (must attend regularly)
Maintain a C average or better in order to be eligible for graduation
Use His/her class time to study and learn
Make an effort not to distract others from their studies, which includes turning off a cell
phone during class time
Obey college rules and on campus traffic regulations
Follow the instructions of CCCTI faculty and staff and of CCCTI Security personnel
According to the CCCTI Student Code of Conduct, students may receive consequences for any of
the following reasons:
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Lewd or indecent conduct including physical or verbal actions; distribution of obscene
materials; lack of appropriate dress; or engaging in harassment or sexual harassment
Drugs or alcohol
Verbal or physical abuse of any person on College premises
Weapons possession
Smoking, eating, or drinking in any unauthorized location
Failure to comply with instructions of College officials acting in performance of their
duties
Students who are suspended or dismissed have specific due process rights as noted in the CCCTI
Student Handbook. The Handbook is available In Adult Education or on the College website at
www.cccti.edu.
______________________________________________________________________________
I have read the above information and will abide by these guidelines AND a copy of the CCCTI
Student Handbook has been made available to me. I understand that my failure to abide by the
policies, rules, and regulations of Caldwell Community College and Technical Institute may
result in my forfeiting the privilege of being a CCCTI student.
Signature of
Student _______________________________________________________________________
If the student has a legal guardian, the parent/legal guardian’s signature is required.
Signature of
Parent/Guardian ________________________________________________________________
Workforce Ready Calendar Dates
2016-2017
Application Process:
May 15, 2016 – July 15, 2016
Application Review
July 18-29, 2016
Continuing Education Registration
Every Tues. from 8am-7pm or go to
Orientation:
(Tuition Payment Due)
Thursday, August 11, 2016
Time 3pm – 5pm
Location: TBA
First Day of Class:
(Fall Semester)
Monday, August 15, 2016
Labor Day Holiday:
Monday, September 5-6, 2016 (no
classes)
Fall Break:
October 10-11, 2016 (no classes)
Veteran’s Day:
November 11, 2016 (no classes)
Thanksgiving Break:
November 23-25, 2016 (no classes)
Last Day of Fall Semester:
Thursday, December 14, 2016
Winter Break:
December 15, 2016-January 8, 2017
First Day of Class:
(Spring Semester)
Tuesday, January 9, 2017
Martin Luther King, Jr. Holiday:
Monday, January 16, 2017
Spring Break:
March 15-17, 2017 (no classes)
Easter Holiday:
Monday, April 17-18, 2017
Last Day of Class:
(Spring Semester)
Thursday, May 8, 2017
Graduation:
Thursday, May 11, 2017
The Broyhill Civic Center
http://www.cccti.edu/coned/Registration/Re
gistrationHome.htm