To Be Completed By ICTC Staff...• Practical • Observant • hysic aly ctive • Step -by s tep hinker • Coordinated School subj ct I lik • Math-Geometry • Chemistry • Trade

2403 N. 41st Street East, Muskogee, OK 74403-1799 P: 918-687-6383 F: 866-261-2041 www.ictctech.com

(Please print clearly when completing application)

Date of Application: _____________

Name:____________________________________________________________________________________ (First) (MI) (Last)

Mailing Address:___________________________________________________________________________ (Address) (City) (State) (Zip)

Student Phone:_______________________________ Email:_______________________________________

Emergency Contact: ____________________________________________________________ (Name) (Relation) (Phone)

(If selected as an ICTC student, please circle your t-shirt size) S M L XL 2XL 3XL 4XL STUDENT INFORMATION RELEASE APPROVAL: This is an authorization for the local school district to release to Indian Capital the student records, including confidential records, concerning my son/daughter as they relate to determining appropriate enrollment. I hereby give approval to have my son/daughter attend ICTC once placement is determined.

________________________________________________ ______________ ______________________________________________ _____________

Signature of parent/guardian Date Signature of applicant Date

To Be Completed By High School Students Only Name of High School: _________________________ Current Grade Level:_____ Date of Birth:_________

Father/Guardian:______________________________________________________________ (First Name) (Last Name) (Place of Employment)

__________________________________________________________________________ (Home Phone) (Cell Phone) (Work Phone) (E-Mail Address)

Mother/Guardian: ______________________________________________________________

(First Name) (Last Name) (Place of Employment)

__________________________________________________________________________ (Home Phone) (Cell Phone) (Work Phone) (E-Mail Address)

To Be Completed By Adult Students Only Are you seeking financial aid? No Yes If you are seeking financial aid from any of the agencies (WIA, TANF, VA, BIA, or Voc-Rehab, etc.) please list the agency: ___________________________________________

Do you have a High School diploma? No Yes Do you have a GED? No Yes; Year______________

Do you have educational records under any other name (i.e. maiden name)? No Yes If yes, what name: ___________________________________________________

List other school(s) attended: __________________________________________ ___________ (School) (Year)

Have you ever attended ICTC as a post-secondary day student? No Yes If yes, year __________

Miscellaneous: Have you ever been convicted of a felony? Yes ______ No _______

If yes, what state(s) _________________________________________________________________________

Have you ever been dismissed from another educational institution for disciplinary action? Yes _____ No ______

** A felony conviction does not necessarily eliminate you from selection or from successfully finding a job after completion. However, failure to provide honest and accurate information on the application will result in dismissal from the application process or school if you have been admitted. **

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Daytime Application 2017-2018 MUSKOGEE

CAMPUS

Choose a Career Major from the following options:

I am interested in the following career major and would like to discuss it with an ICTC counselor:

1st Choice _______________________________________ 2nd Choice ______________________________________

I prefer to attend: _____AM (8:10 – 11:05) _____PM (11:55 – 2:45) _____Both (8:10 – 2:45) Which of the following influenced your decision to attend ICTC? Tech Fest Friend Relative Counselor ICTC Catalog ICTC Website Newspaper Advertisement Other (please specify) ______________________

Notice: Completion of this application by itself does not constitute admission to Indian Capital Technology Center. Please attach the following information to this application for it to be considered complete.

High School Checklist Adult Checklist

High School Transcript High School Transcript or GED Attendance Record CR101 Results Interest Inventory (Contact ICTC for testing schedule) Interest Inventory

An interview to discuss placement will be scheduled upon receipt of the completed application.

Adults Only: After placement in an ICTC career major: If you have disabilities which require reasonable accommodations to perform the essential skills of

the career major, it is your responsibility to provide documentation and to notify your instructor or the student services coordinator. Non-Discrimination Statement: Indian Capital Technology Center is an equal opportunity institution in accordance with civil rights legislation and does not discriminate on the basis of race, color, religion, national origin, sex/gender, age, marital or veteran status, or disability in the operation of its educational programs, activities, recruitment and admission practices. Concerns regarding this policy should be addressed to Sharon Billings, District Compliance Coordinator, at 918-687-6383 or 1-800-375-8324, 2403 N. 41st Street E, Muskogee, OK 74403. Additionally, each campus has a contact in which complaints can be reported.

2403 N. 41st Street East, Muskogee, OK 74403-1799 P: 918-687-6383 F: 866-261-2041 www.ictctech.com

Auto Collision Repair Auto Collision Repair Technician (NATEF compliant)

Auto Service Technology Automotive Service Technician (NATEF compliant)

Business, Management & Administration Executive Administrative Assistant Medical Office Assistant Medical Insurance Coder

Cosmetology Cosmetologist - Public (HS only)

Culinary Arts Culinary Hospitality Assistant

Drafting

Computerized Manufacturing Design

Electricity

Electrician’s Assistant

Graphic Communications Graphic Designer Health Careers Certification Long Term Care/Home Health Care Assistant (HS only)

Heating, Ventilation, & Air Conditioning Residential HVAC Technician

Information Technology Enterprise Network Associate

Machine Tool Manufacturing Technician

Sports Medicine Physical Therapy Aide (HS only)

Service Careers SC Building & Grounds Maintenance Technician’s Assistant

Welding Pipe Welder Structural Welder

Biomedical Academy (HS only)

NAME

SCHOOL

DATE

CAREER CLUSTERS INTEREST SURVEY Circle the items in each box that best describe you. You may make as many or as few circles in each box you choose. Add up the

number of circles in each box. Look to see which three boxes have the highest number.

BO

X 1

Activities that describe what I like to do:

• Learn how things grow and stay alive. • Make the best use of the earth’s natural resources. • Hunt and/or fish. • Protect the environment. • Be outdoors in all kinds of weather. • Plan, budget, and keep records. • Operate machines and keep them in good repair.

Personal qualities that describe me:

• Self-reliant

• Nature lover

• Physically active

• Planner

• Creative problem solver

School subject that I like:

• Math

• Life Science

• Earth Sciences

• Chemistry

• Agriculture

Total number circled in Box

1

BO

X 2


• Read and follow blueprints and/or instructions. • Picture in my mind what a finished product looks like. • Work with my hands. • Perform work that requires precise results. • Solve technical problems. • Visit and learn from beautiful, historic, or interesting

buildings. • Follow logical, step-by-step procedures.

Personal qualities that describe me: • Curious

• Good at following directions

• Pay attention to detail

• Good at visualizing

• Patient and persistent


• Math

• Drafting

• Physical Sciences

• Construction Trades

• Electrical Trades/Heat,

• A/C & Refrigeration/ Technology Education


2

BO

X 3


• Use my imagination to communicate new information to

others. • Perform in front of others. • Read and write. • Play a musical instrument. • Perform creative, artistic activities. • Use video and recording technology. • Design brochures and posters.

Personal qualities that describe me: • Creative and imaginative

• Good communicator/good vocabulary

• Curious about new technology

• Relate well to feelings and thoughts of others

• Determined/tenacious


• Art/Graphic Design

• Music

• Speech & Drama

• Journalism/Literature

• Audio/visual technologies


3

BO

X 4


• Perform routine, organized activities but can be flexible.

• Work with numbers and detailed information.

• Be the leader in a group. • Make business contact with people.

• Work with computer programs. • Create reports and communicate ideas.

• Plan my work and follow instructions without close

supervision.

Personal qualities that describe me: • Compassionate and caring


• Conscientious and careful

• Patient

• Good listener


• Computer Applications/Business and Information Technology

• Accounting

• Math

• English

• Economics


4

BO

X 5


• Work under pressure.

• Help sick people and animals.

• Make decisions based on logic and information.

• Participate in health and science classes.

• Respond quickly and calmly in emergencies.

• Work as a member of a team.

• Follow guidelines precisely and meet strict standards of

accuracy.

Personal qualities that describe me: • Compassionate and caring


• Conscientious and careful

• Patient

• Good listener


• Biological Sciences

• Chemistry

• Math

• Language Arts

• Occupational Health

Classes


5

(Turn over to complete back)

BO

X 6


• Interpret formulas.

• Find the answers to questions.

• Work in a laboratory. • Figure out how things work and investigate new things.

• Explore new technology.

• Experiment to find the best way to do something.

• Pay attention to details and help things be precise.


• Detail-oriented

• Inquisitive

• Objective

• Methodical

• Mechanically inclined


• Math

• Science

• Drafting/Computer-aided

Drafting

• Electronics/Computer

Networking

• Technical

Classes/Technology Education


6

BO

X 7


• Care about people, their needs, and their problems.

• Participate in community services and/or volunteering.

• Listen to other people’s viewpoints.

• Help people be at their best.

• Work with people from preschool age to old age.

• Think of new ways to do things.

• Make friends with different kinds of people.


• Good communicator/listener

• Caring

• Non-materialistic

• Uses intuition and logic

• Non-judgmental


• Language Arts/Speech

• Psychology/Sociology

• Family & Consumer Sciences

• Finance

• Foreign Language


7

BO

X 8


• Work with computers.

• Reason clearly and logically to solve complex problems.

• Use machines, techniques, and processes.

• Read technical materials and diagrams and solve technical problems.

• Adapt to change.

• Play video games and figure out how they work.

• Concentrate for long periods without being distracted.

Personal qualities that describe me: • Logical/analytical thinker

• Sees detail in the big picture

• Persistent

• Good concentration skills

• Precise and accurate


• Math

• Science

• Computer Tech/ Applications

• Communications

• Graphic Design


8

BO

X 9


• Work with hands and learn best that way.

• Put things together.

• Do routine, organized and accurate work.

• Perform activities that produce tangible results.

• Apply math to work out solutions.

• Use hand and power tools and operate equipment/machinery.


• Practical

• Observant

• Physically active

• Step-by-step thinker

• Coordinated


• Math-Geometry

• Chemistry

• Trade and Industry courses

• Physics

• Language Arts


9

BO

X 1

0

Activities that describe what I like to do: • Travel

• See well and have quick reflexes.

• Solve mechanical problems.

• Design efficient processes.

• Anticipate needs and prepare to meet them.

• Move things one place to another.

Personal qualities that describe me: • Realistic

• Mechanical

• Coordinated

• Observant

• Planner

School subject that I like: • Math

• Economics

• Trade and Industry courses

• Physical Sciences



10

BO

X 1

1

Activities that describe what I like to do: • Investigate new places and activities.

• Work with all ages and types of people.

• Organize activities in which other people enjoy themselves.

• Have a flexible schedule.

• Help people make up their minds. • Communicate easily, tactfully, and courteously.

Learn about other cultures.

Personal qualities that describe me: • Tactful

• Self-motivatedl

• Works well with others

• Outgoing • Slow to anger

School subject that I like: • Language Arts/Speech


• Social Sciences

• Marketing • Food Services


11

Identify the boxes with the three highest numbers and list them in order on the lines below:

1st Highest 2nd Highest 3rd Highest

Locate the cluster(s) below that relate to your three highest boxes. Circle the ICTC Career Major you are most interested in learning more about.

Cluster Description ICTC Career Major(s)

BOX 1

AGRICULTURE, FOOD & NATURAL RESOURCES

The production, processing, marketing, distribution, financing, and development of agricultural commodities and resources including food, fiber, wood products, natural resources, horticulture, and other plant and animal products/resources.

* Service Careers Building & Grounds Maintenance Technician’s Assistant

BOX 2 ARCHITECTURE & CONSTRUCTION

Careers in designing, planning, managing, building, and maintaining the built environment.

*Computerized Manufacturing Design *Electrician’s Assistant *Residential HVAC Technician

BOX 3 ARTS, A/V TECHNOLOGY & COMMUNICATIONS

Designing, producing, exhibiting, performing, writing, and publishing multimedia content including visual and performing arts and design, journalism, and entertainment services.

*Graphic Designer

BOX 4 BUSINESS, MANAGEMENT & ADMINISTRATION

Careers that encompass planning, organizing, directing and evaluating business function essential to efficient and productive business operations.

*Executive Administrative Assistant *Medical Office Assistant *Medical Insurance Coder

BOX 5 HEALTH SCIENCE

Occupations that require planning, managing, and providing therapeutic services, diagnostic services, health informatics, support services, and biotechnology research and development.

*LongTerm Care/Home Health Care Assistant (HS Only)

* Nursing Transitions (2nd Year Students- By Approval Only) *Sports Medicine (HS Only) *Practical Nursing (Adult Only) *Radiologic Tech (Adult Only) *Occupational Therapy Asst (Adult Only)

BOX 6 SCIENCE, TECHNOLOGY, ENGINEERING, & MATHEMATICS

Careers that encompass the management, marketing and operations of restaurants and other food services, lodging, attractions, and recreation events and travel-related services.

*Project Lead the Way Biomedical Science Academy

BOX 7 HUMAN SERVICES

Preparing individuals for employment in career pathways that relate to family and human needs.

*Cosmetologist – Public (HS Only)

BOX 8 INFORMATION TECHNOLOGY

Building linkages in IT occupations framework for entry-level, technical, and professional careers related to the design, development, support and management of hardware, software, multimedia, and systems integration services.

*Enterprise Network Associate *CISCO Network Associate *Home Technology Integrator *Network Management & Support

BOX 9 MANUFACTURING

Processing of materials into intermediate or final products and related professional and technical support activities such as production planning and control, maintenance, and manufacturing/process engineering.

*Manufacturing Technician *Pipe Welder *Structural Welder

BOX 10 TRANSPORTATION, DISTRIBUTION & LOGISTICS

Planning, management, and movement of people, materials, and goods by road, pipeline, air, rail, and water and related professional and technical support services.

*Automotive Service Technician (NATEF Compliant) *Auto Collision Repair Technician (NATEF Compliant)

BOX 11 HOSPITALITY & TOURISM

Hospitality and Tourism encompasses the management, marketing, and operations of restaurants and other food services, lodging, attractions, and recreation events and travel-related services.

*Culinary Hospitality Assistant

Note: Your interests may change from time-to-time. These survey results are intended to help you with informal career exploration for the career majors that are offered at our school. It does not make any claims of statistical reliability.

For more information, check with a career counselor at your high school, Career Tech Center, higher education institution, or one-stop career centers.

Indian Capital Technology Center does not discriminate on the basis of race, color, religion, national origin,

sex/gender, age, disability, marital or veteran status.

Documents

To Be Completed By ICTC Staff...• Practical • Observant • hysic aly ctive • Step -by s tep hinker • Coordinated School subj ct I lik • Math-Geometry • Chemistry • Trade