This Version:
This version is archived at: http://www.shawmuteducation.org/OSCAP/sestudentapplication.2.en.html
| Submit | |
| Please answer all questions and submit with a completed referral form from a service provider. If you need help obtaining a referral please let us know at 617-532-1906. Your application will be complete once the referral form is received. | |
Student Application |
|
| 1. | LAST NAME |
| 2. | FIRST NAME |
| 3. | MIDDLE INITIAL |
| 4. | DATE OF BIRTH |
| 5. | STREET ADDRESS |
| 6. | SOCIAL SECURITY |
| 7. | APT/ROOM# |
| 8. | CITY |
| 9. | STATE |
| 10. | ZIP CODE |
| 11. | PHONE NUMBER |
| 12. | NAME OF PERSON TO CONTACT IN EMERGENCY |
| 13. | RELATIONSHIP |
| 14. | ADDRESS |
| 15. | PHONE NUMBER |
| 16. | LAST GRADE COMPLETED |
| 7 | |
| 8 | |
| 9 | |
| 10 | |
| 11 | |
| 12 | |
| COLLEGE 1 | |
| COLLEGE 2 | |
| COLLEGE 3 | |
| COLLEGE 4 | |
| 17. | BRIEFLY STATE YOUR REASONS FOR WANTING TO ATTEND |
| TO BE COMPLETED BY OFFICE | |
| 18. | REFERRING AGENCY |
| 19. | CASEWORKER NAME |
| 20. | START DATE |
| 21. | APPLICATION RECEIVED DATE |
| 22. | STUDENT NUMBER |
| 23. | RESERVATION NUMBER |
| 24. | INSTRUCTOR |
| 25. | LIFE LEVEL |
| GED | |
| HS DIPLOMA | |
| VETERAN | |
| CHILDREN | |
| 26. | NUMBER OF CHILDREN |
| 27. | CHILDCARE NEEDED |
| 28. | SITE DESIGNATION |
| TIMOTHY SMITH CENTER | |
| ALLSTON NEIGHBORHOOD NETWORK | |
| CAMBRIDGEPORT | |
| COMMUNITY LEARNING CENTER | |
| 29. | TYPING SPEED (WPM) |
| 10 - 20 | |
| 20 - 30 | |
| 30 - 40 | |
| 40 - 50 | |
| 50 - 60 | |
| 60 - 70 | |
| 80 OR MORE | |
| THANKS! | |
| Submit | |
