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Ben Franklin Career and Technical Center
Application for Adult Preparatory Programs
WVEIS #: _________________
Full Day ________
Half Day ________
For Office Use Only
Last Name __________________, First Name ______________________ Middle Name _________________
Street Address ____________________________________________________________________________
City ________________,
State ____
Zip Code __________________
County ________________
Home Phone (___) ___-____ Work/Cell Phone (___) ___-____
Social Security # ___-__-____
Date of Birth (MM/DD/YYYY) __/__/____ Place of Birth (City, State) ______________________________
Class Requested : _________________________________________________________________________
Emergency Contact: Name: _______________________________
Phone number _____________
Family Doctor: ________________________________ Doctor’s Phone # ___________________________
Highest Grade Completed in High School: _________ Years in College: _______
Name of High School or GED Center: ________________________________________________
Address of High School/ GED Center _________________________________________________________
Optional Information: Gender ______ Race ___________________ Country of Citizenship ____________________
Name/Address of All Schools attended after high school:
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
_____________________________________________________
Selective Service # ____________________
Health Insurance # ___________________
Mark the Tests taken:
__ TABE __ACT __SAT Other: _________
Test Location: _______________________
Test Date: __________________________
Check Financial Aid/Benefits that you are interested in or qualify for:
__ 13th Year Assistance __ Job Corps __Pell Grant
__VA __GI Bill
__Social Security
__Voc. Rehabilitation __WIA
__Other ________________________ Verified by: _____________________
Adult Preparatory Guidelines
Requirements for Adult Preparatory Programs
Daytime Classes meet: 8 a.m. to 2:30 p.m. Evening Classes meet: 3 p.m. to
8:30 p.m. Classes meet 5 days per week for a total of 9 or 11 months, as
specified by each class.
Students enrolled in full-time post-secondary or Adult
Preparatory Training courses will participate in a Job Skills
Portfolio Program, which is designed to enhance their abilities to
gain employment after completing their vocational coursework.
Tuition is due and payable in advance. Your tuitions is due at the start of
each semester. Failure to make tuition payment on time could result in
your being terminated from your program.
Absenteeism: Only excused absences (personal illness and other such
absence as declared excusable by the office) will be acceptable for
continuation in your program. Twelve or more unexcused absences could
result in termination. If you will be late or absent from class, call the
school at (304) 766-0369 before class begins.
Parking: Parking is permitted only in the marked spaces of the main lot.
The first three rows are reserved for faculty. Permits may be required and
purchased in the office.
Smoking and the possession of tobacco products is prohibited by WV Code
while on school property.
Breaks: You will receive 2 ten minute breaks daily. No food or drinks are
permitted in the classrooms.
Alcohol/Drugs: The use of sale of alcohol or drugs while on school
property or while attending class at Ben Franklin will be cause for
suspension, termination, and possible prosecution.
Students will also participate in a workplace skills course that will
acquaint them with the WorkKeys assessment skill set. The
purpose of this is to prepare students for this work-force entry
exam. These skills include math, reading, and locating
information. Students who are found to need assistance may
obtain it from one of our specialists.
I HAVE READ AND UNDERSTAND THE REQUIREMENTS AND GUIDELINES ON THIS
PAGE.
SIGNATURE: __________________________________________
DATE: ___________________
____ Please indicate if the applicant wishes ti take
advantage of any program modifications needed while
attending public schools:
Explain: _______________________________________
_______________________________________________
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