Register for Experience LTC

*First Name:

*Last Name:

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Social Security Number (optional):

*Date of Birth (MM-DD-YYYY):

*Home phone:

*Best time to call:

Cell phone:

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*Parent/Guardian Name:

*High School Attending:

*Year of graduation:

*High School counselor:

Choose ONE program from Session A and a DIFFERENT program from Session B

Choose One Session A ProgramAccountingAutomotive Maintenance Technician and Auto Collision Repair & Refinish TechnicianBusiness ManagementCriminal Justice-Law EnforcementDental Assistant and Dental HygienistEarly Childhood Education and Child Care ServicesElectro-Mechanical TechnologyGraphic and Web DesignIndustrial MaintenanceIT-Computer Support Specialist and IT-Network SpecialistJudicial Reporting/Broadcast CaptioningNursing Programs/Medical AssistantOphthalmic Medical AssistantParalegalParamedic Technician/EMTPharmacy Technician and Pharmacy Services ManagementRadiographySupply Chain Management/Quality Assurance TechnicianWelding-Industrial

Choose One Session B ProgramAdministrative Professional and Office AssistantApprenticeshipsAutomotive Maintenance Technician and Auto Collision Repair & Refinish TechnicianCriminal Justice-Law EnforcementDairy Herd ManagementEarly Childhood Education and Child Care ServicesElectro-Mechanical TechnologyEnergy (Wind, Nuclear, and Energy Management)Fire MedicFrom Pink to Green: Careers for Women in a Green EconomyHealth Unit Coordinator and Health Care TechnicianHorticulture TechnicianHotel and Hospitality ManagementHuman Resources AdministrationIT-Web and Software DeveloperMachine Tool OperationMarketingMechanical Design TechnologyMedical Administrative Specialist/TranscriptionistNursing Programs/Medical AssistantParamedic/EMTPharmacy Technician and Pharmacy Services ManagementRadiographyWelding-Industrial

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