Ben Franklin Career & Technical Education Center
Application for Adult Preparatory Program
WVEIS:______________________________
Last Name:_________________________ First Name:________________________ Middle Name:_____________________________
Address:____________________________________City:___________________________ State: _____ Zip Code:_________________
County:________________________ Birth Place:__________________________ Birth Date:_________________________________
Home Phone Number:_________________________________
Cell Phone Number:___________________________________
Person to Contact in Case of Emergency:________________________________ Phone:______________________________________
Family Doctor:_____________________________________________________ Phone:______________________________________
Class Requested: ________________________________
*Gender: Female or Male
*Social Security Number:________-________-________
*Race:_______________________ *Country of Citizenship:___________________________________
*These above items are optional
Highest Grade Level Completed (Circle one): 7 8 9 10 11 12 College: 1 2 3 4 4+
High School or GED Center or College Name: _____________________________________________________________________
City, State, Zip:______________________________________________________________________________________________
Name / Addresses of ALL schools attended after high school:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
Selective Service #:_________________________Full day:_____
Adult Prepatory Guidelines
Requirements for Adult Preparatory Programs
at Ben Franklin
Class Time: Day 8:00 a.m. to 2:00 p.m., Evenings 3:00 p.m.-8:30 p.m.
Five days per week for a total of eleven months or as specified by
each class.
Tuition: Due and payable in advance. Your tuition is due at the start
of each semester. Failure to make tuition payment on time could
result in your being terminated from the program.
Absenteeism: Only excused absences (personal illness and other such
absences as declared excusable by the administration) will be
acceptable for the continuation in you 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 main lot in the marked off
area. The first four rows are reserved for faculty.
Smoking: No smoking or possession of tobacco products are permitted on school property.
Breaks: At present, you have two ten minute breaks, one each in the
morning and afternoon. Food and drink are not permitted in the
classrooms.
Alcohol/Drugs: The use or sale of alcohol or drugs while on school
property or attending classes at Ben Franklin will be cause for
suspension, termination, and possible prosecution.
Health Ins Card #:__________________________ Half day:_____
Circle test(s) taken: TABE
ACT
SAT
WorkKeys
Other
Test Location:_________________________________________
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.
Students will also participate in basic skills activities that will introduce
them to basic PC and Internet usage as well as prepare them for
standardized testing in Math, Reading, and the location of information.
Students will be tested in Math, Reading, and Locating Information and
may schedule time with our specialists in these areas. This is
recommended for anyone experiencing difficulty in these areas.
I HAVE READ AND UNDERSTAND THE ABOVE REQUIREMENTS AND
GUIDELINES ON THIS PAGE.
Signature:_____________________________________________
Date:_________________________________________________
Please indicate if the applicant wishes to take advantage of any program
modifications needed while attending public schools. Yes / No
If yes, please explain:
As required by federal law and regulations, the Kanawha County Board of Education does not discriminate on the basis of sex, race, color, religion,
disability, age or national origin in employment and in the administration of any of its education programs and activities. Inquiries may be directed to
JeaneAnn Hershcer, Title IX Coordinator, (304) 348-1379, or to Jim Mullins, Section 504 Coordinator, (304) 348-1366, Kanawha County Board of
Education, 200 Elizabeth Street, Charleston, WV 25311-2119, or the US Department of Education’s Director of the Office of Civil Rights, (215) 596-6795.