Concord Regional Technical Center

Welcome

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If you would like to learn more about CRTC, please complete this form. By doing so, you will be kept up to date regarding upcoming events, application deadlines, and other opportunities at CRTC. ****Please note, this is NOT the CRTC application. That is a different form.

About the Student

One piece of information in each block section. Put your information in the block above the words.

Name

First

Middle

Last

Preferred Name

Gender

Date of Birth

mm/dd/yyyy

Applying to CRTC for what Grade

For the Fall of

Current School

Student School Email

Student Personal Email

Hometown

Program Interests

Select your program(s) of interest.

First Choice

Second Choice

Third Choice

Future CRTC Planning

If there is a program that you are interested in, but do not see above, please list here.

About Your Parent/Guardian

Name

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Parent 1 phone (xxx-xxx-xxxx)

Type

Number

SMS Opt In By selecting yes, you are agreeing to receive SMS text messages from Concord Regional Technical Center. Notification frequency varies. Message & data rates may apply. To opt-out of all SMS notifications from this organization, select no or text STOP to 1-855-213-7400.

Yes No

Parent 2 phone (xxx-xxx-xxxx)

Type

Number

Yes No

Parent Email

Parent Mailing Address

Thank you for reaching out to us! Just out of curiosity...

How did you hear about Concord Regional Technical Center? (check all that apply)

CRTC brochure

CRTC assembly at my school

A current/former CRTC student

A parent/guardian or sibling who attended the CRTC

School counselor

Social Media

I'm not sure

Other

Please specify