2023-2024 Inspire Career Education Program Packet

Parent/Guardian Information
REQUIRED: This section is required for applicants under the age of 18. All applicants under the age of 18 or involved with DHR are required to complete the parent and guardian information section of the application.
Is the applicant or family involved in an open court case? This includes County, Municipal, DHR, Family Court, etc.*

YesNo
Court Liaisons, Case Workers, and/or Probation Officer Name and Phone Numbers. Please list all including Guardian at Litem*
Guardian

PrefixFirst NameLast Name
Guardian Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Guardian Phone Number

Area CodePhone Number
Guardian E-mail
example@example.com

Education Background
Last School and Grade Attended*
If the last school you attended was high school, how many credits were you away from graduation?*
Have you ever received special education accommodations? This includes IEP, Reading, etc. Please select all that apply:*
What would you say is your most challenging subject?*
What is the easiest subject?*
Is there anything else needed to share about participant education plan/services*

Needs Assessment
Do you have reliable transportation? If you do not transportation will be provided.*

YesNo
Please list how you will get to and from class*
If you need transportation you are required to provide a 24 hour notice each time to be added to the transportation route.
Will you need childcare? This applies to 6 week to pre-school aged children.*

YesNo
CCDN provides Life Services which include food from our food pantry, diapers, and financial resource assistance. All students that need Life Services will participate in the CCDN Bucks Program which includes volunteerism at the CCDN. Would you like to sign up for CCDN Life Services?*

YesNo
CCDN provides group and individual counseling services. Would you like to sign up for counseling?*

YesNo

Emergency Contacts

List 2 people we may contact on your behalf in case of emergency
Emergency Contact 1*

First NameLast Name
Emergency Contact 1 Phone Number*

Area CodePhone Number
Emergency Contact 2 Email*
example@example.com
Emergency Contact 2*

First NameLast Name
Emergency Contact 2 Phone Number*

Area CodePhone Number
Emergency Contact 2 Email*
example@example.com

Guidelines, Rules, Policies
Please review the 2022-2023 Rules and Regulations for the Inspire Education Academy. We reserve the right to suspend and/or dismiss students for any policy infractions and/or health and safety violations

Class Schedule
- Regular Class attends class Tuesdays and Thursdays 9:00 AM-2:00 PM
- GED Prep Students Mondays and Wednesdays 2:00 PM-4:00 PM
Breaks
- Students will get two (1) fifteen (15) minute break and 1 (30) thirty-minute break. One of the two breaks will be designated for lunch.
Safety and Security
- There is a zero 0 tolerance for drugs, alcohol, drug paraphernalia, and weapons on CCDN Property. If you are caught with any of these items or conversations of trying to purchase drugs, alcohol, weapons or drug paraphernalia on our grounds is immediate grounds for dismissal of the CCDN Inspire Academy Program.
- If you are court involved, we are required to report any violations of rules to the courts (i.e. parole, judges, attorneys, case workers, social workers, and/or counselors)
- Smoking If you smoke the designated smoking area is on the side of the building next to the pallets. Do not leave cigarette buts, black and mild filters, or trash in the designated smoking area. Students under the age of 21: There is absolutely no smoking of any kind of drug on or around our property.
Attendance Policy
- Students may only miss 2 days within the program.
- Students who are sick must provide a doctor's excuse to obtain an excused absence.
Conduct Policy
- Every Student is required to be respectful at all times. No exceptions.
  Respect includes, but is not limited to, your expressed wording, body language, tone of voice, and/or how you speak to instructors, volunteers, staff, visitors, and your peers. Your tone of voice will be carried appropriately using an inside tone.
- Disputes and disagreements shall be handled only by management.
- Do not ask staff, visitors, instructors, or volunteers for anything that does not pertain to program which includes, but not limited to, money, gifts, etc.
  This type of behavior is considered inappropriate and disrespectful.
- Please be mindful of conversations you have at our facilities, (especially with your peers), because some conversations may be deemed inappropriate. Any inappropriate conversation including, but not limited to, sex, fighting, drugs, drug
  sales, drug sharing, ‘hooking up’, etc. are deemed not inappropriate conversations within this facility. The conversations you feel are private are not so private and do get around.
- Behaviors, words, acts, and/or gestures that may deemed as aggressive and/or violent in nature are prohibited. This includes, but is not limited to, mouthing threatening/aggressive words/comments, whispering threatening/aggressive words/comments, aggressive/violent body language that displays anything that could be considered or deemed aggressive or violent in nature.
- No sleeping in class. This would be considered an unapproved absence from class which will be subject to the attendance policy.
- No blurting out, cursing, arguing, or disrespectful tones/words.
- No weapons of any kind.
- No smoking, drugs, alcohol, prescription/over the counter drugs/medicines, and/or illegal substances of any kind are permitted on premises regardless of its location.
- No attending class impaired by any legal or illegal substance and/or induced behavior that causes or appear to cause any form of impairment whatsoever.
- No display of inappropriate relationships on the premises. Intimate relationships are to be left at home.
- No sexual harassment or racist comments of any kind permitted.
Cell Phones
- Cell phones are not to be out while in class. All students are required to put their cell phones away. If you are caught with your cell phone out this is breaking a rule that will call for immediate dismissal from class.
Transportation
- KNOW… Your transportation is a courtesy, It is not a mandatory requirement for this program. We reserve the right to revoke this courtesy at any time for any reason.
- Students are expected to be ready to leave for transport at 7:30 AM every morning. NO EXCEPTIONS! Our transportation driver that picks up from Bessemer to Leeds.
  The same conduct policy applies from the time you are picked up to the time you are dropped off at home and all communication you may have with our transport driver.
- Students will be picked up from their home address ONLY and dropped back off at their home address ONLY.
- Transportation will not be provided to any other locations except for approved court and medical visits.
Meals and Snacks
- Do not enter the kitchen area. Breakfast bars and snacks will be provided in the mornings upstairs in the classroom.
  - Lunch will be provided on a designated 30-minute break as a courtesy. If you do not like what we offer for lunch, you are more than welcome to bring your own lunch each day.
  - You are required to clean any area you utilize for any reason which includes food and/or beverage items.
- Cleaning Up
  - All students are required to clean up in their designated area after class.
  - Students shall use sanitation supplies to clean off their desks, computer heads, and computers.
  - Students will throw away all their trash items used throughout the day.
  - Students will clean up behind themselves if they make a mess in other parts of the building such as desks, outside the building, and/or bathrooms.
Tutoring Sessions
- Tutoring Sessions are available only during the days you are not required to be physically present in class. No exceptions.
Example: Students who attend classes on Mondays and Wednesdays can get extra tutoring in the evenings on Tuesdays and Thursdays.
Students who attend classes on Tuesdays and Thursdays may get extra tutoring in the mornings of Mondays and Wednesdays
GED Students who need tutoring may get extra tutoring in the mornings of Mondays and Wednesdays.
Please submit last report card/progress report

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Please submit medical insurance card

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Inspire Career Education Academy

Applicant Information

Parent/Guardian Information

Education Background

Needs Assessment

Career Questionnaire

Emergency Contacts

Criminal Background Questionnaire

Guidelines, Rules, Policies