Cumberland Perry Area CTC Fire and EMS Program Application
Student Last Name
*
Student Middle Name
Student First Name
*
Birthdate (mm/dd/yyyy)
*
Current Grade Level
*
12
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student Email
*
example@example.com
Current High School Attending
*
Boiling Springs
Big Spring
Biglerville
Camp Hill
Carlisle
Cumberland Valley
East Pennsboro
Greenwood
Mechanicsburg
Newport
Northern York
Susquenita
Trinity
West Perry
West Shore-Cedar Cliff
West Shore-Red Land
West Shore Christian Academy
Upper Adams Christian Academy
.
School Counselor at Current High School
Parent/Guardian
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
-
Area Code
Phone Number
Parent/Guardian Email
*
example@example.com
I attest that all information is correct in my application and I understand that I am only applying to Cumberland-Perry AVTS and this does not constitute acceptance. Please Sign Below.
*
Submit
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