STUDENT APPLICATION FOR BEN FRANKLIN CAREER CENTER
Name ____________________________________WVEIS Number_____________________ High School __
Current Grade Level____________
Current Grade Point Average ______________
Number of Days Absent Current School Year
Email ___________________________________________
Address_______________________
City
Phone # ____________________
Best number to reach parent/guardian
State
Zip
Alternate Number ___________________________
You may find a complete description of courses offered at Ben Franklin at http://kcs.kana.k12.wv.us
Weighted/Honors Courses
Two Year Programs
_____ *Power and Energy (1 to 4 yrs option) _____Automotive Technology
_____ *Medical Assisting (2 yr)
_____ Building Construction
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Diesel
______*Pre-Nursing (2 yr)
_____Electrical Technology
_____ Early Childhood Education
____ Health Occupations
____ HVAC / Sheet Metal
____ Manufacturing
____Metals Technology
One Year Programs
____ CISCO Networking
____ Computer Aided Drafting/Design
____ Computer Systems Repair
_______ Law Enforcement
_____ Manufacturing (AM)
_____ Robotics (PM)
INDICATE PROGRAM(S) YOU WISH TO ENROLL BY PLACING A "1" IN YOUR FIRST CHOICE (IF you have a second
choice place a”2”AND a "3" IF you have a third choice.)
What is your reason for wanting to enroll in this program?______________________________________________
What are your plans after high school? work__ college__ career training,
military_____
other___
References (Someone not related to you):
Name: __________________________
Phone:______________
Name: __________________________
Phone:______________
Student Signature: _________________ Date__________________________
Parent Signature: __________________ Date: __________
Ben Franklin is a simulated work site requiring all students to agree to drug testing.
Non-Discrimination:This Company prohibits discrimination against or harassment of any person employed by or seeking
employment with the CTE program because of race, creed, religion, color, or national origin or because of age, physical or
mental disability, or sex.
Do Not Write Below This Line (Home School Use Only)
Student GPA________
Days Absent in current year______ Number of Failed Classes____
·
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