Apply to Bridge

Student Information

I have previously attended White's Jr/Sr High Schoolrequired

Yes

No

Student First Namerequired

Student Middle Initialrequired

Student Last Namerequired

Maiden Name (if applicable)

Date of Birthrequired

Must contain a date in M/D/YYYY format

Grade Levelrequired

Must contain only numbers

Student Criteria and Barriers

The student meets the following criteria for placementrequired

Student would benefit from instruction offered in a manner different from traditional school.

Student is a parent or expectant parent and is unable to regularly attend school.

Student employment is necessary to support family and conflicts with the school day.

Student has been suspended or expelled from school.

Additional barriers to education for the student (check any that apply)required

Other barriers (from checkbox above)

Name of last school attendedrequired

Must contain only letters and spaces

Address of last school attendedrequired

Must contain only letters, numbers and spaces

Phone number of last school attendedrequired

Must contain only letters, numbers and spaces

IEP or 504 Planrequired

Yes

No

Please list any medical concerns or medications.0 / 1000

The Civil Rights Act of 1964, Title VI, Language Minority Compliance Procedures, requires school districts and charter schools to determine the language(s) spoken in each student’s home in order to identify their specific language needs. This information is essential in order for schools to provide meaningful instruction for all students as outlined Plyler v. Doe, 457 U.S. 202 (1982). The purpose of this survey is to determine the primary or home language of the student. The HLS must be given to all students enrolled in the school district / charter school. The HLS is administered one time, upon initial enrollment in Indiana, and remains in the student's cumulative file. Please note that the answers to the survey below are student-specific. If a language other than English is recorded for ANY of the survey questions below, the W-APT or WIDA Screener will be administered to determine whether or not the student will qualify for additional English language development support. Please answer the following questions regarding the language spoken by the student:

What is the native language of the STUDENT?required

What language(s) is spoken most often by the STUDENT?required

What language(s) is spoken by the STUDENT in the home?required

Addressrequired

Cityrequired

Staterequired

Zip Coderequired

Must contain only numbers

Home Phone Numberrequired

Must contain only letters, numbers and spaces

Student Cell Phone Number

Must contain only letters, numbers and spaces

Student Email address

Type of diploma desired:

Is the student currently employed

Yes

No

Current Course Schedule

CURRENT TRANSCRIPT needed prior to finalizing new schedule.

Current Course: 1

Current Course: 2

Current Course: 3

Current Course: 4

Current Course: 5

Current Course: 6

Intended length of enrollment and goal(s)0 / 1000

Coaches' Contact Information

(i.e. Parent/Guardian, Probation Officer, etc.)

1. Name

1. Relationship

1. Phone Number(s)

1. Email Address

2. Name

2. Relationship

2. Phone Number(s)

2. Email Address

3. Name

3. Relationship

3. Phone Number(s)

3. Email Address

Media Release

Opportunities may arise to publicly share information about Bridge and celebrate its students. This may be done with images, videos, and/or other identifying information of students.

Published items, such as photos and videos, may appear in newsletters, brochures, newspapers, along with district, school, community, or other affiliated websites and social media.

Bridge students may choose to grant or deny media permission.

By granting media permission:

I agree to release and hold harmless MSD of Wabash County and its representatives from and against any and all claims, demands, actions, complaints, suits, and other forms of liability that may arise out of the publication of information outlined above.
I agree that no compensation will be due or paid to me or my child because of the publication of the information outlined above.
I understand that MSD of Wabash County will take photos and videos at Bridge graduation ceremonies. While student media preference will be considered at these public events, this form has no legal bearing at graduation ceremonies. MSD of Wabash County may freely promote these events and capture photos and/or videos at graduation ceremonies. Audience members may also capture photos or videos at these events and publish at their discretion.

Do you grant media permission for this student?required

I grant media permission.

I do NOT grant media permission.

Sign and Submit

Please enter your digital signature by typing your first and last name in the field belowrequired

How did you learn about Bridge?required

District

Quicklinks

In This Section

Application Process

Complete Application Form

Complete Application or Interest Form

Application Form

Bridge Application Form

Student Information

Student Criteria and Barriers

Current Course Schedule

Coaches' Contact Information

Media Release

Sign and Submit

More Information Form

School Records Requested

Transition Coordinator Connects

Orientation Course

Enrollment Meeting