VPAC VOCATION STUDENT APPLICATION 2026-2027

Student Information

Student Last Name

Student First Name

Preferred Name (if different)

Student Address

Street Address

Street Address Line 2

CityState

Postal / Zip Code

County

Social Security Number

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Date of Birth

Date

Age

Picture of the front of your ID

Picture of the back of your ID

Do you have a Connecting Colorado Account?

Do you receive Medicaid

Medicaid Number

If you don't have one, just put 0.

Do you receive EBT_SNAP

What is your EBT_SNAP Card Number?

If you don't have one, just put 0.

Do you receive TANF

What is your County caseworker's name?

If you don't know, just put N/A.

You are REQUIRED to attend an Individualized Care and Educational Plan Meeting (ICEP Meeting). During your ICEP Meeting, you will meet with a VPAC Team Member, gain an understanding of expectations and commitments, receive your ICEP and set goals with our Behavioral Health Team. All students will be invited to receive Behavioral Health resource hours. Which Friday will you be attending?

What Curriculums are you interested in?

How are you feeling today?

What support do you need today?

Why do you want to attend VPAC and obtain one of the few seats available?

Anything else you want us to know?

You must qualify and comply with VPAC expectations. Do you understand that completion of this form does not secure your enrollment?

How did you hear about VPAC?

I am applying for admission to the Victory Project-based Academics & Competency (VPAC) programs listed above.

I AM AWARE THAT CARE AND TREATMENT IN THIS AREA ARE NOT AN EXACT SCIENCE. I ACKNOWLEDGE THAT NO GUARANTEES HAVE BEEN MADE TO ME AS TO THE RESULT OF SAID EDUCATION AND TREATMENT AT VPAC.

I CERTIFY THAT I HAVE READ AND FULLY UNDERSTAND THE CONTENTS OF THIS FORM AND THAT ALL STATEMENTS ARE TRUE TO THE BEST OF MY KNOWLEDGE.

I hereby permit VPAC to contact me after my discharge from the program to obtain information for research purposes only. All information will be considered confidential.

Signature

Date