BLUE RIVER CAREER PROGRAMS NEW STUDENT APPLICATION 2026-2027 SCHOOL YEAR Step 1 of 2 50% SECTION ONEStudent Legal Name :* First Middle Last Student Phone Number :*Student Email :* Date of Birth :*Legal Gender :Select OptionFemaleMaleGrad Year :*Select One202720282029Home School :*Select OptionSHS – Shelbyville High SchoolTCHS – Triton Central High SchoolSWHS – Southwestern High SchoolMHS – Morristown Jr. Sr. High SchoolWHS – Waldron Jr. Sr. High SchoolStudent Mailing Address :* Street Address City ZIP Code Legal Guardian Father Mother Parents Guardian Father Name :* First Last Father's Phone Number :*Father's Email Address :*Mother Name :* First Last Mother's Phone Number :*Mother's Email Address :*Guardian Name :* First Last Guardian's Phone Number :*Guardian's Email Address :*Parent/Guardian Home Address (if different) : Street Address City ZIP Code Student Accommodations (IEP, ILP, or 504) Yes No Select Accommodations IEP ILP 504 SECTION TWOChoose your first and second program choices.First Choice ProgramPlease choose your first type of program from the dropdown menu.Select your first choiceAuto Collision RepairAutomotive ServicesConstruction TradesCriminal JusticeCulinary ArtsFire & RescueEducation ProfessionsElectrical TradesHealth Sciences/CNAHealth Sciences/CCMASocial & Community ServicesWelding TechnologyWork Based Learning* Dual College Credit May Be Available* Dual College Credit May Be Available* Dual College Credit May Be Available* Dual College Credit May Be Available* Dual College Credit May Be Available● - Minimum Age Requirement (17 by May 2027)* Dual College Credit May Be Available* Dual College Credit May Be Available# ^ - Minimum Age Requirement (16 by May 2027) With Criminal History Report Required # ^ - Minimum Age Requirement (17 by May 2027) With Criminal History Report Required * Dual College Credit May Be Available* Dual College Credit May Be AvailableSecond Choice ProgramPlease choose your first type of program from the dropdown menu.Select your second choiceAuto Collision RepairAutomotive ServicesConstruction TradesCriminal JusticeCulinary ArtsFire & RescueEducation ProfessionsElectrical TradesHealth Sciences/CNAHealth Sciences/CCMASocial & Community ServicesWelding TechnologyWork Based Learning* Dual College Credit May Be Available* Dual College Credit May Be Available* Dual College Credit May Be Available* Dual College Credit May Be Available* Dual College Credit May Be Available● - Minimum Age Requirement (17 by May 2027)* Dual College Credit May Be Available* Dual College Credit May Be Available# ^ - Minimum Age Requirement (16 by May 2027) With Criminal History Report Required # ^ - Minimum Age Requirement (17 by May 2027) With Criminal History Report Required * Dual College Credit May Be Available* Dual College Credit May Be AvailableSECTION THREE - Student• Briefly describe why you want to take a career program class :*• List classes you have taken in high school and work experiences which relate to your career program choice :*• Do you have any health problems or physical limitations that Blue River Career Programs should be aware of or may require special accommodations?* No Yes • Please describe :*This field is hidden when viewing the formSECTION FOUR - Home School CounselorThis field is hidden when viewing the formStudent Legal Name :* First Last This field is hidden when viewing the formCurrent GPA :This field is hidden when viewing the formCredits earned :This field is hidden when viewing the formSTN :This field is hidden when viewing the form# of days absent year to date :This field is hidden when viewing the formDiploma Track :Please diploma track from the dropdown menu.Core 40Academic HonorsTechnical HonorsGeneralCert. of CompletionThis field is hidden when viewing the formIEP : Yes No This field is hidden when viewing the form504 : Yes No This field is hidden when viewing the formSAC/AtoE : Yes No This field is hidden when viewing the formIvy Tech Community College C number if applicable :This field is hidden when viewing the formPassed English GQE : Yes No This field is hidden when viewing the formPassed Algebra GQE : Yes No This field is hidden when viewing the formIs This Class Being Audited? : Yes No This field is hidden when viewing the formIf Yes : Semester 1 or Semester 2 or Both This field is hidden when viewing the formDiscipline Concerns (if any) :This field is hidden when viewing the formComments :This field is hidden when viewing the formCounselor’s Signature :This field is hidden when viewing the formDate:*This field is hidden when viewing the formSECTION FIVE - BRCPThis field is hidden when viewing the formBRCP Director: Approved : Yes No This field is hidden when viewing the formDirector’s Signature :This field is hidden when viewing the formDate :This field is hidden when viewing the formComments :CONSENT TO RELEASE*✔ I AGREE to release information regarding my enrollment (emancipated student) or my student’s enrollment in a career or technical education course to potential employers that contact the school to recruit students with particular career and technical skills. The school shall also provide enrollment information to the Department of Workforce Development (DWD) through the InTERS reporting system. The DWD may provide the enrollment information to potential employers that contact the DWD to recruit students with particular career and technical education skills. Yes No I understand the information may be released orally or in the form of copies of written enrollment information, when preferred by the requester. I have a right to inspect any written information released pursuant to this Consent. I understand I may revoke this Consent upon providing written notice to the Governor's Workforce Cabinet's Office of Career and Technical Education by emailling CTE@gov.IN.gov. I further understand that until this revocation is made, this consent shall remain in effect and my enrollment information will continue to be provided as detailed in this Consent.This field is hidden when viewing the formDo you want consent to refuse?* Yes No
