Skills Center Student Application

Student Application

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Student Information
Name*

First NameLast Name
Address

Street Address

Street Address Line 2

CityState (two letter)

Postal / Zip Code (five digit)
Mobile*

Area CodePhone Number
Work

Area CodePhone Number
Home

Area CodePhone Number
Other

Area CodePhone Number
Email*
example@example.com
Work Email
example@example.com
Other Email
example@example.com
Have you ever worked for BCI, Skills Center, or any affiliate of Boone Center, Inc.?
If yes, explain when you worked for us!
To the best of your knowledge, are you related to (or at any time once related to) an employee of BCI, Skills Center, or any of the affiliates of Boone Center, Inc?
If yes, explain to whom you are related (or were related).

Vocational Profile

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Which one of Skills Center's vocational programs interests you the most? *
Do you have the right to work in the United States of America?
Have you ever received funding from any of the following:*
DDRB = Development Disabilities Resource Board (Hold Ctrl for multiple Options)
Do you receive Social Security or Medicaid?*
If yes the Benefits case manager will contact you to set up a meeting.
Do you have an ABLE account?
To learn more about ABLE accounts visit: http://www.ablenrc.org/about/what-are-able-accounts
Tell us about how you plan to get to work and to class at the Skills Center.*
What are your plans for (A) getting to and from Skills Center (B) getting to and from work?
Accommodations
The BCI Skills Center is committed to helping our students get the accommodations they require to experience success with their new career. This is why we want to know about any accommodations you need to be successful.
What accommodations do you require?
Hold Ctrl to select more than one
Use this space to explain any accommodations selected above
Guardianship
Do you have a legal guardian?*
Legal Guardian = A person who has been appointed by a judge
What is your guardian's first name?
First name only
What is your guardian's last name?
Last name only
Relationship Nature
Please select choice if any above are filled.
What sort of relationship do you have with your guardian?
Street Address
What is your guardian's street address?
City
In what city does your guardian live?
State
Two letter postal abbreviation (Ex: OK, KS, MO, CA)
Zip/Postal Code
Five digit zip code
What is your guardian's phone number?

Area CodePhone Number
What is your guardian's email address?
example@example.com

Criminal History

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Having a criminal record does not necessarilly disqualify you from attending the BCI Skills Center. We simply ask prospective students to be honest since failure to disclose criminal history could disqualify students from future job placement opportunities.

Furthermore, all Skills Center applicants are subject to a criminal background screening prior to enrollment to protect both our students' valuable time and the community employers we partner with who may not hire people under certain legal circumstances.
Do you have any criminal offenses to report?*
If yes, please explain in detail the nature of your offense(s). *
If no type N/A
Are you currently indicted or have current charges?*
If yes, please explain. *
If no type N/A
Do you have any sex-related offenses?*
If yes, please explain.*
If no type N/A

Commitment to Diversity

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Skills Center is committed to having a Zero Tolerance policy for discrimination based on any demographic information provided in this application. This information is gathered solely for the purpose of striving to serve a student population that closely reflects the members of our community. Therefore, the applicant, by providing this information, understands that all information provided below is voluntary.
Gender
Date of Birth*

MonthDayYear
Select the date you were born
Race/Ethnicity
Veteran Status

Final Questions

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What other vocational interests do you have?
Hold Ctrl to select more than one option
How did you hear about Skills Center?*
If you selected "Other", please put here how you heard of us.
If you selected "Other School District", please use this box to tell us which one.
I hereby declare that the provided information in this application is true. I also hereby consent to Skills Center contacting me through the contact information provided in this application.

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I helped complete this application:
Complete this if you are completing this application on someone's behalf. Otherwise, leave blank.
Application Date:*

MonthDayYear
Please select the current date
Verify you are not a robot!*
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Student Application

Student Information

Vocational Profile

Accommodations

Guardianship

Criminal History

Commitment to Diversity

Final Questions