Register for Experience LTC

*First Name:

*Last Name:

*Address:

*City:

*State:

*Zip Code:

Social Security Number (optional):

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

*Home phone:

*Best time to call:

Cell phone:

Email:

*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 ProgramAccountingApprenticeshipsAutomotive Maintenance Technician and Auto Collision Repair & Refinish TechnicianBusiness ManagementCriminal Justice-Law EnforcementCulinary ArtsDairy Herd ManagementEarly Childhood Education and Child Care ServicesElectro-Mechanical TechnologyEnergy Management TechnologyGraphic and Web DesignHorticulture/Sustainable LandscapingIndustrial MaintenanceIT Programs—IT-Computer Support Specialist, IT-Network Specialist, IT-Web and Software DeveloperJudicial Reporting/Broadcast CaptioningMechanical Design TechnologyNuclear TechnologyNursing Programs/Medical AssistantOphthalmic Medical AssistantParalegalParamedic Technician/EMTPharmacy TechnicianManufacturing Management/Quality Assurance/Supply Chain ManagementRadiographyWelding-IndustrialWind Technology

Choose One Session B ProgramAdministrative Assistant/Office AssistantApprenticeshipAutomotive Maintenance Technician and Auto Collision Repair & Refinish TechnicianCriminal Justice-Law EnforcementCulinary ArtsDental Assistant/Dental HygienistEarly Childhood Education and Child Care ServicesElectro-Mechanical TechnologyEnvironmental Engineering--WasteFire MedicHealth Unit CoordinatorHotel/Hospitality Management & Golf Course ManagementHuman Resources AdministrationIT-Web and Software DeveloperMachine Tool OperationMarketingNursing Programs/Medical AssistantOphthalmic AssistantWelding-Industrial

How did you hear about Experience LTC?