2022-2023 First Year High School Student Application
This application is for students who are NOT CURRENTLY enrolled in an SCCC program. This information will be sent to your counselor and principal for approval.
Student Legal Name
*
First Name
Middle Name
Last Name
Suffix
Student Current Grade Level:
*
11
10
Anticipated Year of Graduation
*
Please Select
2023
2024
What high school do you attend?
*
Please Select
Alton
Bakersfield
Dora
Gainesville
Houston
Lutie
Mountain View-Birch Tree
Oregon-Howell (Koshkonong)
Summersville
Thayer
West Plains
Willow Springs
Winona
West Plains
Other-Homeschool
FIRST CHOICE PROGRAM-What SCCC program/class are you wanting to attend?
*
Please Select
Auto Body & Collision Repair I
Auto Mechanics Technology I
Carpentry I
Commercial & Advertising Art I
Culinary Arts I
Health Science I
Information Technology I
Health Science II/CNA (SENIORS ONLY)
Pharmacy Technician (SENIORS ONLY; PM ONLY)
Welding Technology I
COE/SMEE/SBE (West Plains High School Seniors ONLY)
Please note that any health science program (including Health Science II/CNA and Pharmacy Tech) requires student drug testing.
ALTERNATE PROGRAM-If your first choice is not available, what other program would you like to attend?
*
Please Select
Auto Body & Collision Repair I
Auto Mechanics Technology I
Carpentry I
Commercial & Advertising Art I
Culinary Arts I
Health Science I
Information Technology I
Health Science II/CNA (SENIORS ONLY)
Pharmacy Technician (SENIORS ONLY; PM ONLY)
Welding Technology I
COE/SMEE/SBE (West Plains High School Seniors ONLY)
NO ALTERNATE-If I don't get my first choice, I don't want to attend SCCC.
Please note that any health science program (including Health Science II/CNA and Pharmacy Tech) requires student drug testing.
Statement of Purpose: Briefly explain why you wish to enroll in a program at SCCC.
*
Use complete sentences and include what your plans are after graduation. It will not be graded for anything, but is just a way for us to get to know you better.
Student Email Address
*
example@example.com
Student Phone Number
*
Please enter a valid phone number.
Student Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Student County
*
(Ex. Howell, Oregon, Ozark, Shannon, Texas, etc.)
Student Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Student Signature
*
Clear
Date
*
-
Month
-
Day
Year
Date
Optional Demographic Information
The following information will be used to verify program representation. Supplying this information is optional and will have no impact on your application.
Student Gender:
Please Select
Female
Male
Prefer not to say
Student Race:
Asian
Black
Hispanic
Indian
Multi-race
Pacific Islander
White
Do you currently have an IEP and/or Section 504 plan?
Please Select
Yes
No
This optional information will ONLY be used to assist with collection of information from your sending school and for statistical purposes. It will have absolutely no impact on your application to SCCC.
Submit
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