NORTHWESTTECHNOLOGYCENTER

1801 South 11th Street

Alva, Oklahoma73717

580.327.0344 Phone

580.327.5467 Fax

SECONDARY ENROLLMENT

Social Security Number: / Enrollment Date:
HomeHigh School: / Grade Level: / 9 / 10 / 11 / 12
Name:
(First) / (MI) / (Last) / (Other Name)
Home Address:
(Street, route, or box number)
(City, state, zip)
Home Phone: / E-mail:
Cell Phone: / Work Phone:
Names of parents or guardians:
Father’s Name: / E-mail:
Home Phone: / Cell Phone:
Employer Name: / Work Phone:
Mother’s Name: / E-mail:
Home Phone: / Cell Phone:
Employer Name: / Work Phone:
Modifications/accommodations needed in order to be successful in your training program:

All students will be given a standardized assessment before enrollment is granted. Assessment results are used to assist in program placement and career counseling. Please inform us if you need accommodations in order to successfully participate in the assessment process.

Place a “1” by your first choice and a “2” by your second choice:

AutoCollision Technology / Health Careers Certification
Auto Technology / Service Technology
Business and Information Technology / Web Development and Graphic Design
Time Desired: / AM / PM / Full Time / 2 hr block / 1 hr block
Reason for selecting this time:

I have reviewed my son's or daughter's pre-enrollment for NorthwestTechnologyCenter.I give NorthwestTechnologyCenterpermissiontoobtain records from his/her home school.

Parent or Guardian’s Signature / Date
Partner School Representative’s Signature / Date

Northwest Technology Center does not discriminate against any individual on the basis of sex/gender, race, color, religion, age, national origin, disability, or veteran status in the operation of its educational programs, activities, recruitment, admissions, or employment practices.Inquiries may be referred to NWTC, Compliance Coordinator, 1801 S. 11th Street, Alva, OK73717, or (580) 327-0344.

“DRUG-FREESCHOOL AND CAMPUSES” PROGRAM

Realizing that student safety is of great concern, the Northwest Technology Center has implemented a program to prevent the unlawful possession, use, distribution, or being under the influence of illicit drugs and alcohol by students and employees on school property or as part of any school activity.

The use of illicit drugs and the unlawful possession and use of alcohol is wrong and harmful to a student’s health. The health risks associated with drug and alcohol use includes but are not limited to:

  • Slowing of physical reflexes
  • Mental powers decreased
  • Impaired judgment
  • Emotional problems
  • Spread of disease (AIDS) by drug paraphernalia

The “Code of Conduct” for students attending NorthwestTechnologyCenter explicitly prohibits the unlawful possession, use, being under the influence, or distribution of drugs or alcohol on school property or as part of any school activity.

Any student who violates this “Code of Conduct” will be subject to disciplinary action which may include suspension, expulsion, and referral to law enforcement agencies for prosecution.

Each student is hereby notified that a condition of enrollment, the student must agree, in writing, to abide by the terms of this policy.

NorthwestTechnologyCenter hereby commits itself to a continuing good faith effort to maintain a drug-free school. Throughout the school year, students will be required to attend drug awareness programs which will educate students about the dangers of drug abuse, available drug counseling, rehabilitation and re-entry programs and in-depth discussion of the school “Drug-Free Program”.

I, ______, do hereby acknowledge by my signature that I have reviewed, discussed, and understand the “Drug-FreeSchool and Campuses” program of the NorthwestTechnologyCenter, Alva Campus. I also agree to abide by the rules and guidelines therein.

Student’s Signature / Date
Parent or Guardian’s Signature / Date

Northwest Technology Center’s Student Handbook can be found at If computer access is not available to you, you may obtain a hard copy of the handbook in the school office.

I, ______, do hereby acknowledge by my signature that I have reviewed, discussed, and understand the Student Handbook of the Northwest Technology Center, Alva Campus, and agree to abide by the rules and guidelines therein. I also understand that I can access the Student Handbook online, or that I may obtain my personal hard copy in the school office.