Thornton Township Academy of Truck & Diesel Technology Powered by

Student Application

Instructions: Please PRINT and provide all of the following information. Only students completing 9th grade are eligible to apply. Completed Student Applications are to be returned to your counselor no later than February 1, 2016.

Name: _____________________________ ___________________________ ID # ___________________

Last First

School (Circle): TR TT TWCounselor: ______________________________________

Mailing Address: ___________________________________________________________________________

City: ____________________________________________State: ______Zip: _____________

Home Phone: (______) ______- _____________Student Cell Phone: (______) ______- ________________

Student Email Address: ______________________________________________________________________

Parent/Guardian Name: ________________________________ ____________________________________ Last First

Work Phone: (______) ______- _____________Parent Cell Phone: (______) ______- _________________

Parent Email Address: _______________________________________________________________________

Please select which careers interest you. If you select “other”, please briefly name or describe that choice.

_____ Truck Technician_____ Diesel Mechanic

_____ Service Manager_____ Heavy Equipment Service Technician

_____ Power Plant Technician_____ Parts Manager

_____ Owner, Diesel Repair Business_____ Automotive Technician

_____ Engineer_____ Engineer Technician

_____ Other (Please describe) ________________________________________________________________

(over)

List all student activities (clubs and sports teams) for which you are a member:

Briefly describe why you should be selected as a member of the Thornton Township Academy of Truck & Diesel Technology – Powered by Navistar.

The Thornton Township Academy of Truck and Diesel Technology – Powered by Navistar is housed in the Vocational Technical Building at Thornton Township High School and is a three-year curriculum. The program of study includes a double period course during 10th grade, a triple period course during 11th grade, and a triple period course combined with a possible cooperative education experience during 12th grade.

Parent/Guardian Consent

I, __________________________________________, have read, understand, and consent to

(Print Parent/Guardian Name)

________________________________________ applying for membership in the Thornton Township

(Print Student Name)

Academy of Truck & Diesel Technology – Powered by Navistar. I agree and support his/her participation and

abide by all Thornton Township High School District 205 rules and requirements.

Parent/Guardian Signature: ______________________________________ Date: _____________________

IMPORTANT: Thornton Township Truck & Diesel Academy – Powered by Navistar does not discriminate on the basis of race, color, national origin, age, religion, non-disqualifying handicapping condition or gender in its educational programs or employment.

Thornton Township Academy of Truck & Diesel Technology – Powered by Navistar!

15001 S. BroadwayHarvey, IL 60426Phone 708-225-4193 Fax 708-225-5046