25-26 CPACTC New Student Application

Student Last Name*

Capitalize the first letter

Student First Name*

Capitalize the first letter

Student Middle Name*

Capitalize the first letter

Birthdate (mm/dd/yyyy)*

Current Grade Level*

Address*

Street Address

Street Address Line 2 such as P.O. Box or Apt #

CityState / Province

Postal / Zip Code

Student Email *

example@example.com

Current High School Attending or will attend if in 8th grade*

*The application portal for 8th grade students will open in the spring. Only students from West Shore School District and Big Spring School District may apply in 8th grade.

If You Selected "Other", Please Write Your Current High School Below

High School Attending For the 25-26 School Year*

Current Middle School Attending - current 8th grade students only

*Only students from West Shore School District and Big Spring School District may apply in 8th grade.

Student Currently Lives With*

Both ParentsFather OnlyMother OnlyOther

Parent/Guardian Prefix*

Parent/Guardian*

First NameLast Name

Parent/Guardian Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Parent/Guardian Phone Number*

Area CodePhone Number

Parent/Guardian Email*

example@example.com

First Program Choice? *

Second Program Choice? *

Third Program Choice?

Name of Academic Teacher Who Will Complete Your Recommendation?*

English, Social Studies, Math, Science

Please Input Email of Academic Teacher for Recommendation*

example@example.com. Be sure to verify their correct email on your high school's website or ask your teacher.

Name of Elective Teacher Who Will Complete Your Recommendation*

Tech Ed, World Language, Music, Art, Health/PE, Ag, etc.

Please Input Email of Elective Teacher for Recommendation*

example@example.com. Be sure to verify their correct email on your high school's website or ask your teacher.

I attest that all information is correct in my application and I understand that I am only applying to Cumberland Perry Area CTC and this does not constitute acceptance. Please Sign below. *

The Cumberland Perry Area Career & Technical Center does not discriminate on the basis of race, color, national origin, sex, disability or age in its programs or activities and provides equal access to the Boy Scouts and other designated youth groups. The Cumberland Perry Area Career & Technical Center does not discriminate in any manner, including Title IX sexual harassment, in any school program or activity. The school has established Title IX personnel to promptly respond to concerns and reports of sexual harassment and assault. All investigations into reports of sexual harassment and assault will be impartial, free of bias and conflicts, and will not prejudge the facts for either side. The school strives to maintain an environment where all students, staff, and greater community feel safe. Inquiries may be directed to the CPACTC Title IX Coordinator or the Section 504 Coordinator: Administrative Director, 110 Old Willow Mill Road, Mechanicsburg, PA 17050 or 717-697-0354 or jbruhn@cpatech.org.

CPACTC New Student Application 2025-2026