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Bridge Application Form

To begin the application process for Bridge, please complete the form below. **If you have any problems submitting your application, please contact our director Tonya Boone at boonet@msdwc.k12.in.us.**

Required

Student Information

I have previously attended White's Jr/Sr High Schoolrequired
Must contain a date in M/D/YYYY format
Must contain only numbers

Student Criteria and Barriers

The student meets the following criteria for placementrequired
Additional barriers to education for the student (check any that apply)required
Must contain only letters and spaces
Must contain only letters, numbers and spaces
Must contain only letters, numbers and spaces
IEP or 504 Planrequired
0 / 1000

Language

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:

Important: WIDA Scores and ILP Needed

Because you answered with a language other than English to one or more of the questions above, please contact your current or previous guidance department to request copies of your latest WIDA scores as well as your Individual Learning Plan (ILP). Copies of those need to be sent to: bridgeadmin@msdwc.k12.in.us

Contact Information

Must contain only numbers
Must contain only letters, numbers and spaces
Must contain only letters, numbers and spaces
Is the student currently employed

Current Course Schedule

CURRENT TRANSCRIPT needed prior to finalizing new schedule.
0 / 1000

Coaches' Contact Information

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

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

Sign and Submit

Submitting this form does not guarantee enrollment in Bridge. A program representative will contact you soon to discuss enrollment.

How did you learn about Bridge?required