2025-2026 Inspire Education Academy 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.
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
YesNo
Please list how you will get to and from class*
YesNo
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 2025-2026 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 Monday-Thursday 9:00 AM-2:00 PM
- Students will get one (2) fifteen (15) 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)
- There is absolutely no smoking of any kind of drug on or around our property.
Attendance Policy
- 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. We reserve the right to take up cell phones during class and workshops
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 7:00 AM every morning. NO EXCEPTIONS! Transportation starts at 7:30 AM
  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
- Students are responsible for brining their lunch and snacks.
- Do not enter the kitchen area.
- 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.
Please submit student records, last report card, progress report, attendance records, withdrawal records, etc.

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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