Student Application

Student Application

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Student Information
Student Status
Name *

First Name Last Name
Address

Street Address

Street Address Line 2

City State (two letter)

Postal / Zip Code (five digit)
Mobile

Area Code Phone Number
Work

Area Code Phone Number
Home

Area Code Phone Number
Other

Area Code Phone 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?
Are you able to stand for 10 hours?
Note: The ability to stand for 10 hours is required for our Manufacturing programs
Do you receive funding from DDRB or Regional Center?
DDRB = Developmental Disabilities Resource Board
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
Important!

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?
Do you have a guardian? *
What is your guardian's first name?
First name only
What is your guardian's last name?
Last name only
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 Code Phone 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).
Are you currently indicted or have current charges? *
If yes, please explain.
Do you have any sex-related offenses?
If yes, please explain.

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 *

Month Day Year
Select the date you were born
Race/Ethnicity
Veteran Status

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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? *
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.

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

Month Day Year
Please select the current date
Verify you are not a robot! *
Should be Empty:

Student Application

Student Information

Vocational Profile

Accommodations

Guardianship

Criminal History

Commitment to Diversity

Almost Done!