High School Education Response Form

First Name:		Last Name:
Email:		Phone:
Street:
City:		State:
Zip:		Student	Parent

Student Home School	Anna Local Schools Botkins Local Schools Bradford Local Schools Covington Exempted Village Schools Fairlawn Local Schools Ft. Loramie Local Schools Houston Local Schools Jackson Center Local Schools Lehman Catholic High School Newton Local Schools Piqua City Schools Russia Local Schools Sidney City Schools Troy City Schools Other
Current Grade
7       8       9       10       11

Areas of Interest
Agriculture and Environmental Systems
	Ag and Power Technology
	Environmental Occupations
	Landscape Management
Art and Communication
	Graphic Arts/Printing
Business and Administrative Services
	Administrative Office Technology
	Business and Financial Management
	International Business
Construction Technologies
	Building and Grounds Maintenance
	Carpentry
	Electrical Trades
	Heating, Ventilation, Air Conditioning and Refrigeration
Education and Training
	Early Childhood Education and Care
	Teacher Academy
Engineering and Science Technologies
	Computer Aided Drafting and Design
	Pre-Engineering Tech Prep
Health Science
	Medical Technologies
Hospitaility and Tourism
	Chef Training
	Hospitality and Facility Care
Human Services
	Cosmetology
Information Technology
	Computer Information Technology
	Interactive Media
Manufacturing Technologies
	Electronics
	Welding Technology
	Machine Technology
Transportation Systems
	Auto Collision Repair Technology
	Auto Services
	Auto Technology
Other Options
	School-to-Apprenticeship

What are your plans after graduation?
College       Career Technical Certification       Military Service       Employment
Would you like to be contacted by UVJVS staff?	Yes          No
Would you like to receive periodic information/news from the UVJVS?	Yes          No
Preferred Method of Contact	Email Phone Address