uid: WANIC - New Application

New Application (Screen 1/2)

Thank you for your interest in WANIC Skill Center! To apply for a WANIC program, please fill out the Application below. All sections must be complete before your application will be considered.
Please see your High School Career Specialist with registration questions.
Fields marked with a * must be filled in before Application may be submitted.
Students who do not have a middle name should put "None" in the box.
Legal Last Name: *
Legal First Name: *
Legal Middle Name: *
Enter "none" if you do not have a middle name
Address: *
City: *
State: *
Zip Code: *
Primary Phone: *
Cell Phone:
Student E-Mail: *
Gender: *
Month: Day: Year:
City: State: Country:
Primary Home Language:
US Citizen:
Years in Country:
High School I will be Attending in Fall: *
Name of the School I am currently attending:
Has this student ever been enrolled in the Lake Washington School District? (check if "yes")
Select Program: *
Second Choice Program:
Third Choice Program:
Graduation year: *
Summer Skills Academy T-shirt Size:
(T-shirt is included in class/materials fee)
Health Alerts:
Washington state law (RCW 28A.210.320) requires that medication or treatment orders, medications, and a health care plan be in place prior to the start of school. WANIC does not discriminate on the basis of health conditions or special needs. Read more in the ADA Notification at the bottom of this page.

If student requires medication at school, complete the form linked below the health questions and turn it in to WANIC prior to beginning Summer School.
*Student does not have any health conditions that will affect him/her at school
*Student has a serious health condition that may affect him/her at school

Life threatening allergy to:
Behavioural health diagnosis:
Cardiac Diagnosis:
Cardiac Restrictions:
Diabetes - Will need insulin at school? (yes/no):
Seizure disorder (type):
Asthma - Will student need inhaler at school? (yes/no):
Activity Restrictions:
If student requires medication at school, complete the Authorization for Medication Form and turn it in to WANIC prior to beginning Summer School. All medications must be brought in on the first day of class and given to the School Nurse, the WANIC office manager, or the student's Instructor. All prescription medications must be in the original container with a pharmacy label that matches the health care provider orders. Over-the-counter medications and supplements must be in the original container marked with the student's name. Parents must collect any remaining medications on or before the last day of class.

Authorization form: http://www.lwsd.org/school/WaNIC/SiteCollectionDocuments/Authorization-For-Administration-Of-Medication.pdf

* I have carefully read the description and know the specific location of the Summer program I am requesting.

* I have not previously completed this specific WANIC Summer program.

* I will be entering 9th, 10th, 11th or 12th grade in the Fall and I am registered in a public high school in Bellevue, Everett, Issaquah, Lake Washington, Northshore, Riverview, or Snoqualmie Valley School District. (Out-of-consortium students will not be accepted for Summer Skills Academy.)

* Submitting an application is not a guarantee of enrollment. I understand that for the first week online applications are available, rising 12th graders will have priority in the program I am requesting. After that, the program will be filled based on application submission date (“first come, first served”) and space availability. I will be notified by email if I get enrolled in the program or if I get placed on a waitlist.

* If enrolled, I agree to complete the entire program and to attend class every day from 8:00 a.m. until 3:00 p.m. I am responsible to providing my own lunch daily. I understand that shortly after 3:00 p.m. the building will be closed and there is no after-school program.

* I understand the WANIC Summer attendance policy: I am enrolling in a multiple period class; missing one day in this WANIC program is the same as missing multiple days of a regular one period class. I understand that if I miss more than one day I may lost credit for the program and this will be reflected on my high school transcript. I will bring a parent note to my teacher, or my parent will email/call the WANIC office immediately following an absence. It is my responsibility to follow up with the teacher for any missed work due to an absence.

* The Summer program earns a 0.5 high school credit (Occupational Education, unless otherwise specified in the program description). I understand this credit and my grade will be reflected on my high school transcript. I know that Tech Prep college credits are not available for Summer Skills Academy.

* I have reliable transportation to and from class each day. I will schedule/provide ample travel-time to and from the program location. My program is [see mileage chart] miles from my high school. It is my responsibility to find out what the parking policies are at the location I will be attending and I will be responsible for any parking fees, if applicable.

* I am aware of the $50 materials/class fee. I understand this payment is due only after I have received an email confirming my enrollment in the class. If I get enrolled, I understand this payment is due before June 1st in order to hold my spot in the class. If my class fee is not paid by June 1st, I may forfeit my spot to someone on the waitlist. Fees may be paid online or by check (payable to WANIC).
Parent/Guardian Last Name: *
First Name: *
Email: *
Primary Phone: *
Work Phone:
Cell Phone:
Relationship to Student: *
Student lives with you?
Parent/Guardian 2:
Last Name:
First Name:
Primary Phone:
Work Phone:
Cell Phone:
Relationship to Student:
Student lives with you?
Emergency Contact:
Last Name:
First Name:
Primary Phone:
Work Phone:
Cell Phone:
Relationship to Student:
Student lives with you?
In compliance with Federal and Washington State data collection requirements, please answer both questions below. If you do not provide this information, WANIC personnel will be required to assign this information for you, based on observation and knowledge of the student.

1. Is student of Hispanic/Latino Origin?
(Check all that apply)
Not Hispanic/Latino Cuban Dominican
Spaniard Puerto Rican Mexican/Mexican American/Chica
Central American South American Latin American
Other Hispanic/Latino
2. What race do you consider student?
(Check all that apply)
African American/Black White Asian Indian
Cambodian Chinese Filipino
Hmong Indonesian Japanese
Korean Laotian Malaysian
Pakistani Singaporean Taiwanese
Thai Vietnamese Other Asian
Native Hawaiian Fijian Guamanian or Chamorro
Mariana Islander Melanesian Micronesian
Samoan Tongan Other Pacific Islander
Alaska Native Chehalis Colville
Cowlitz Hoh Jamestown
Kalispel Lower Elwha Lummi
Makah Muckleshoot Nisqually
Nooksack Port Gamble Klallam Puyallup
Quileute Quinault Samish
Sauk-Suiattle Shoalwater Skokomish
Snoqualmie Spokane Squaxin Island
Stilliguamish Suquamish Swinomish
Tulalip Yakama Other Washington Indian
Other American Indian
The Lake Washington School District does not discriminate on the basis of race, color, national origin, sex, disability, age, gender, marital status, creed, religion, honorably discharged veteran, military status, sexual orientation including gender expression or identity, the presence of any sensory, mental or physical disability, the use of a trained guide dog or service animal by a person with a disability, in its programs and activities and provides equal access to the Boy Scouts and other designated youth groups. The Lake Washington School District offers classes in career and technical education program areas under a non-discriminatory policy. Specifically, the Lake Washington School District offers classes to students based on educational criteria in programs like Auto Tech, Family Consumer Science, etc., through an enrollment process that is free from discrimination. For more information about the application process and particular course offerings, contact the Career & Technology office at (425) 936-1387. English language proficiency is not a consideration in the offering of classes or the participation requirements for career and technical education classes. This notification can be provided in the appropriate language for communities of national origin by contacting our Communications Department at (425) 936-1300. The following has been designated to handle inquiries regarding the nondiscrimination policies:
Director of Human Resources, 16250 NE 74th Street, Redmond Washington, 98052, (425) 936-1266