Career Academy Pre-Registration

Student Information

Student Legal First Name:
*
First Name is Required

Preferred Name:

Student MI:

Student Last Name:
*
Last Name is Required

Student Mailing Address:
*
Address is Required

City:
*
City is Required

State:
*
State is Required

Zip:
*
Zip is Required

Student DOB: mm/dd/yyyy
*
Birthday is Required

Student Phone: xxx-xxx-xxxx
*
Cell Phone is Required
Enter in the given format.

Student Personal Email Address:
*
Email Address is Required.
Enter a valid email address.

Gender:*

Male

Female

Gender is Required

US Citizen:*

Yes

US Citizen is Required

Hispanic/Latino:*

Yes

Hispanic/Latino is Required

Ethnicity/Race:*

American Indian or Alaskan Native

Asian

Black or African American

Hispanic/Latino

Native Hawaiian or Other Pacific Islander

White

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High School Information
Home High School: * Home High School is Required	High School Graduation Year: * (4 digit year) Graduation Year is Required
Student High School Email Address: * High School Email Address is Required	Parent/Guardian Name(s): * Parent Guardian Name is Required
Parent/Guardian Phone:(xxx-xxx-xxxx) * Parent Guardian Phone is Required

DMACC Career Academy Opportunities

Select DMACC Year: * DMACC Year is Required	Career Academy: * Career Academy is Required

Program: * Program is Required	Section: * Section is Required

Your admittance to DMACC Career Academy is based upon:
1. Meeting your high school requirements
2. Availability of space within the academy
High school counselors will be notified if an academy is full.

* I understand, if I have an IEP and/or 504 plan, that I must complete the DMACC Disabilities Services Application for Accommodation in order to be considered for the appropriate accommodations. This Acknowledgement is Required.
* I understand it is my responsibility to provide transportation to and from the academy and any respective work sites. This Acknowledgement is Required.
* I have discussed enrolling with my parent and/or guardian and they have given approval for my enrollment into the career academy. This Acknowledgement is Required.
* I understand FERPA rights apply to all students who attend postsecondary institutions and if I would like a parent or guardian to have access to my DMACC information, I will have to complete a FERPA Release Form at https://www.dmacc.edu/ferpa/ferpaexceptions.html and submit it to DMACC's Registrar's Office. This Acknowledgement is Required.