STUDENT ENROLLMENT FORM 2019-2020

PROGRAM CHOICE: *

NOTE: The likelihood of being placed in your program choice increases if you have flexibility to attend AM or PM. Therefore, select AM Only or PM Only if your home school schedule and/or transportation situation prohibit you from attending either session.
Classes start at approximately 7:35 a.m. and 12:15 p.m. each day. This means students driving or riding considerable distance must allow adequate time to be on time. In some cases, students must be at their home school to catch the bus as early as 6:30 a.m. Be sure you are willing to make this early commitment!

STUDENT DEMOGRAPHICS

LAST NAME: *

FIRST NAME: *

MIDDLE NAME: *

DATE OF BIRTH (mm/dd/yyyy): *

GENDER: *

HIGH SCHOOL: *

IF "OTHER", SCHOOL ATTENDING:

CURRENT GRADE: *

PRIMARY ETHNICITY: *

SECONDARY ETHNICITY:

Primary language at home if not English:

HOUSEHOLD INFORMATION

STUDENT RESIDES WITH: *

OTHER:

PRIMARY ADDRESS: *

CITY: *

ZIP: *

PARENT/GUARDIAN 1: *

RELATIONSHIP: *

HOME PHONE: *

WORK PHONE:

CELL PHONE:

PARENT EMAIL ADDRESS: *

STUDENT EMAIL ADDRESS: *

PARENT/GUARDIAN 2:

RELATIONSHIP:

GUARDIAN 2 ADDRESS:

GUARDIAN 2 CITY:

GUARDIAN 2 ZIP:

HOME PHONE:

WORK PHONE:

CELL PHONE:

OTHER INFORMATION - Answering yes to the following questions will not prohibit you from attending ERESA programs.

Do you have any medical or physical problems we should know about?*

If yes, explain:

Does the student have an IEP or 504 Plan?? *

Are you currently on court ordered probation?*

Are you a teen parent?*

STUDENT COMMITMENT

By submitting this form, I certify that I am planning to attend the Eaton RESA Career Preparation Center (ERESA-CPC) program chosen above and agree to the following policies which may impact me as a student in these programs.

ATTENDANCE

The Career Preparation Center believes attendance is a habit that is often learned in school and then carried over to the workplace. In order to encourage a good attendance habit, the following policies have been established.

1. If, during the first ten instructional days of the year, a student has three (3) or more absences, the student will be dropped from their ERESA-CPC class and returned to home school to reschedule classes, from which there may be few to pick.

2. Students who miss 5 consecutive days without notifying the ERESA-CPC may be dropped.

3. If a student wishes an absence to be considered excused (such as weather closures, school excused absences, funeral of immediate family, extended or chronic illness, or court appointments outside of the student's control), documentation of the absence MUST BE SUBMITTED TO THE ERESA-CPC OFFICE WITHIN TWO (2) SCHOOL DAYS OF THE ABSENCE.

4. Students who have earned a "D" or below for any trimester or semester grade will be dropped from their ERESA Career Preparation Center class and returned to their home school to reschedule classes.

I have discussed the attendance policy at ERESA-CPC with my parent/guardian. I am able to meet these attendance guidelines.*

TRANSPORTATION

ERESA-CPC advises ALL students who have bus transportation available to use this service. Driving an individual car involves mileage and fuel expenses (and parking costs if attending downtown campus). These costs can become unmanageable for some students and prevent them from completing their program. Note: All Ingham County students have no bus and will have to provide their own transportation. Sample Cost Calculation for Maple Valley student:

62 miles to program round trip/15 mpg of vehicle = 4.13 gallons/day x $3 per gallon fuel cost = $12.40/day.

Classes start at approximately 7:35 a.m. and 12:15 p.m. each day. This means students driving or riding considerable distance must allow adequate time to be on time. In some cases students must be at their home school to catch the bus as early as 6:15 a.m. Be sure you are willing to make this early commitment!

I have discussed with my parent/guardian the best transportation options for my situation, which also meet my local school district requirements. I am able to make a full-year commitment to the program based on this information.*

COMMITMENT TO ATTEND

The ERESA-CPC staff and administration recognize that student plans can change; however, because often there are more students applying for places in our programs than are available, each student is asked to make the following commitment:

By submitting this form, I make a commitment to attend this class beginning Fall 2018. I understand this class runs a full year in length, and I MAKE A COMMITMENT TO ATTEND FOR THE ENTIRE YEAR.

Eaton RESA does not discriminate on the basis of race, color, national origin, sex, (including sexual orientation and transgender identity) disability, age, religion, height, weight, marital or family status, military status, ancestry, genetic information, or any other legally protected category, (collectively, "Protected Classes"), in its programs and activities, including employment opportunities. In addition, arrangements can be made to ensure that the lack of English language proficiency is not a barrier to admission or participation. Civil Rights Coordinators are located at 1790 E. Packard Hwy, Charlotte, Michigan to handle inquiries regarding the nondiscrimination policies and grievance procedures. Telephone (517) 543-5500.