22-LPW TCD 2025-2026 Registration Form

Home School

Additional School - Please leave blank if you attend the school listed above.

To be used only if you attend a school other than the one listed above (example: private school students should note the private school they attend here).

Home School Student ID Number

This is your school ID number.

Student's First and Last Names

First NameLast Name

Student's Preferred Name

For TCD reference only

Gender

Date of Birth

Student's Email Address

Please use your school email address.

Student's Cell Phone Number

Area CodePhone Number

Student's Mailing Address

Street Address (including Apt/Unit #)

Street Address Line 2

City

Postal / Zip Code

Student's T-Shirt Size

Used for program and event t-shirts

Race / Ethnic Code (for state funding purposes only)

How did you hear about TCD? Please check all that apply.

Who is your school counselor?

TCD programs offer dual credit opportunities for students who maintain required grades and attendance. Students who do not maintain the required grades or exceed the number of days absent allowed for their program will be dropped from dual credit. Students will remain enrolled in TCD but will receive high school credit only.

Are you currently a TCD student (during the 24-25 school year)?

Current TCD program:

First Program Choice

Please note: TCD will place you in your first choice if possible. Due to space limitations, TCD may not be able to make changes to your choices after March 7, 2025.

Second Program Choice

This selection should be DIFFERENT from your first choice. Students who do not select a different second program may not be registered for TCD if their first choice is not available.

Third Program Choice

This selection should be DIFFERENT from your first two choices. Students who do not select a different third program may not be registered for TCD if their first two choices are not available.

The Cosmetology program requires students to have a valid social security number in order to register for the IL Licensed Cosmetologist exam after completing two years of our program.

Cosmetology students are required to wear a uniform in order to receive their daily hours.

Shirts and pants sizes are extra small to 5 XL.
Pants come in petite (under 5 ft tall), regular, and tall (over 5 feet, 10 inches tall).

Cosmetology Uniform Shirt Size

Cosmetology Uniform Pants Size

The Nursing Assistant Training Program at TCD requires students:

To be at least 16 years old by September 1st, 2025.
Have a valid social security number by September 1st, 2025.
Have a valid state issued ID by September 1st, 2025.
Provide proof of covid vaccination 1 and 2 or a combination of covid vaccinations. There are no exemptions at this time.
Submit to and pass a 7 panel urine drug screen prior to attending clinicals.
Will need to have a completed physical exam between 6/01/25 - 09/01/25.
Will need to have a 2 step TB skin test or QuantiFERON Gold blood draw.
Have their own transportation to and from clinical sites.

An explanation of these requirements and necessary forms can be found at https://www.tcdupage.org/apps/pages/NATP_Forms.

Will you be 16 year old before September 1st, 2025.

Do you have a valid social security number?

Do you have a valid state issued ID?

You will be expected to follow the TCD NATP Program Requirements.

Student - I agree to follow the TCD NATP Program requirements including receiving the covid vaccinations, and passing the urine drug screen and criminal background check.

Parent/Guardian - I consent to my student following the TCD NATP Program requirements including receiving the covid vaccinations, and passing the urine drug screen and criminal background check.

Students entering the Nursing Assistant Training Program must be 16 years old before September 1st, 2025.

Please select a different program.

This is a requirement for NATP's clinicals and state certification. Students who do not have a valid social security number or state issued ID will not be eligible to be entered in to the Illinois Healthcare Worker Registry and therefore will not be able to attend clinicals or sit for the certification exam.

The covid vaccination and urine drug screen are requirements from the nursing facilities we use for clinical purposes to protect their residents.

These are required to attend clinicals which are required for state certification.

A criminal background check is required per IDPH guidelines.

Will you be a senior during the 25-26 school year?

Students are required to be seniors to enroll in TCD's Medical Assisting program.

Please select a different program.

The Emergency Medical Technician program requires students to be high school seniors, be current with all required vaccinations & other health requirements, have healthcare coverage, and pass a mandatory background check and drug screen.

A valid social security number is required to take the National Registry of EMTs (NREMT) exam.

To be eligible for dual credit through College of DuPage, students are required to have one of the following:

SAT total score of 950 or higher,
ACT composite score of 20 or higher,
2.6/4.0 or 3.6/5.0 non-weighted GPA, or
Reading and writing Accuplacer category one scores.

To maintain dual credit eligibility, students must maintain a grade of 80% or better and may not exceed 20 absences per year.

Will you be a senior during the 25-26 school year?

Students are required to be seniors to enroll in TCD's Emergency Medical Technician program.

Please select a different program.

Completion of all health requirements is mandatory. Specific health requirements are mandated by the clinical sites and are subject to change based on current medical advice and practices.

All required vaccinations and titers must be completed to perform clinical time. Students requiring a series of shots (i.e., Hepatitis B) may begin clinical time if they adhere to the vaccination schedule. TCD’s affiliation agreement with our clinical sites determines which vaccinations students must have. Clinical sites are not required to allow exemptions to students. No clinical sites offer vaccine exemptions for personal reasons. A few allow medical & religious exemptions for the flu shot and religious exemptions for the COVID shot. Students wishing to apply for those exemptions must contact TCD's principal. If an exemption request is denied, TCD is unable to offer an alternative for clinical time. The student may finish the class for a grade, but will not be eligible to take the licensure exam.

Student - I agree to follow the TCD EMT program health requirements including receiving the covid and flu vaccinations unless my exemption request is approved.

Parent/Guardian - I consent to my student following the TCD EMT program health requirements including receiving the covid and flu vaccinations unless their exemption request is approved.

TCD’s affiliation agreement with our clinical sites determines which vaccinations students must have. Clinical sites are not required to allow exemptions to students.

If a student does not agree to follow the health requirements for the program, the student may not attend clinicals and will not be eligible to take the licensure exam.

Allergies - Please leave blank if student does not have allergies.

Medical Condition(s)- Please leave blank if student does not have any medical conditions.

Medication(s)- Please leave blank if student does not take medication.

Primary Parent/Guardian Contact Information

This should be the parent/guardian the student lives with and who should be contacted FIRST in case of emergency.

Parent/Guardian Full Name

First NameLast Name

Parent/Guardian Relationship to Student

Primary Phone Number

Area CodePhone Number

Additional Phone Number

Area CodePhone Number

Parent/Guardian Email Address

TCD uses email as a primary means of communication. Please provide a current email address.

Parent/Guardian Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code

Parent/Guardian Preferred Language

Does this parent/guardian live with this student?

Does this parent/guardian receive mail for this student?

Does this parent/guardian have custody of this student?

Is this parent/guardian an emergency contact for this student?

Can this parent/guardian pick this student up from TCD? (the student can leave TCD with this contact)

Would you like to add an additional contact?

Secondary Parent/Guardian Contact Information

This is a parent/guardian who should be contacted SECOND in case of an emergency.

Parent/Guardian Full Name

First NameLast Name

Parent/Guardian Relationship to Student

Primary Phone Number

Area CodePhone Number

Parent/Guardian Email Address

TCD uses email as a primary means of communication. Please provide a current email address.

Parent/Guardian Mailing Address

Street Address

Street Address Line 2

CityState

Zip Code

Parent/Guardian Preferred Language

Does this parent/guardian live with this student?

Does this parent/guardian have custody of this student?

Does this parent/guardian receive mail for this student?

Is this parent/guardian an emergency contact for this student?

Can this parent/guardian pick this student up from TCD? (the student can leave TCD with this contact)

Emergency Contact Full Name

First NameLast Name

Emergency Contact Relationship to Student

Emergency Contact Phone Number

Area CodePhone Number

Would you like to add an additional emergency contact for this student?

Emergency Contact Full Name

First NameLast Name

Emergency Contact Relationship to Student

Emergency Contact Phone Number

Area CodePhone Number

Why are you interested in attending TCD?

How will your experience in the program you chose prepare you for your post-secondary plans?

Explain how your high school grades and overall GPA reflect your ability to be successful in the program you chose. Have your grades remained consistent throughout high school? If not, what caused the changes?

Attendance is important and, in some programs, mandatory at TCD. Explain your attendance record through your high school career. Please include information regarding arriving late and/or leaving school early and how it reflects your ability to be successful in a TCD program.

Media Release

I hereby acknowledge and grant permission for representatives of Technology Center of DuPage and its governing body (DuPage Area Occupational Education System or DAOES) to use my student's image, voice, and/or identification information for educational, informational, or promotional purposes. This may include release to the news media, posting on the TCD/DAOES websites or World Wide Web, or use in TCD/DAOES publications, presentations, or displays.

Images may include video recordings, photographs, digital images, negatives, or prints. Voice may include audio-video recordings, quotes, or testimonials. Identification information may include my name, hometown, high school, TCD program, grade level, honors/awards, or activities related to my TCD program.

Parent/Guardian - Media Release

Directory Information Release

The primary purpose of directory information is to allow Technology Center of DuPage to include information from your child's education records in certain publications. This information can include: student name, mailing address, telephone listing, photograph, and/or grade level. The telephone listing will be used ONLY for student follow-up study.

Notice for Directory Information
The Family Educational Rights and Privacy Act (FERPA), a federal law, requires that
Technology Center of DuPage, with certain exceptions, obtain a parent’s/guardian’s
written consent prior to the disclosure of personally identifiable information from your child’s education records. However, Technology Center of DuPage may disclose
appropriately designated “directory information” without written consent, unless you have advised the school to the contrary. The primary purpose of directory information is to allow Technology Center of DuPage to include this type of information from your child’s education records in certain publications.

Parent/Guardian - Directory Release

Student Internet Acceptable Use Policy Agreement

My agreement below means that I have read, understand, and agree to follow the guidelines as stated in the TCD Internet Use Policy of the Student/Parent Handbook.

Student - I agree to follow TCD's Internet Acceptable Use Policy.

By selecting "NO", you decline the privilege to use Internet resources and will not be allowed its use during TCD, including TCD's Public WiFi.

Student/Parent Handbook Agreement

Please read TCD's Student/Parent Handbook. By agreeing below, you are agreeing to follow the rules and regulations enclosed within the handbook. Rules/regulations are subject to change without notice.

Student - I have reviewed the TCD Student/Parent Handbook and agree to follow all rules/regulations at TCD.

As a TCD student you will still be bound by rules and regulations contained in the Student / Parent Handbook. It is recommended you take time to review the TCD Student/Parent Handbook.

Parent/Guardian - I have reviewed the TCD Student/Parent Handbook.

A TCD student is bound by rules and regulations contained in the Student / Parent Handbook. It is recommended you take time to review the TCD Student/Parent Handbook.

Parent/Guardian Electronic Signature

The electronic signature and all of its related fields replace a handwritten signature on paper and is legally binding.

TCD fees are separate and in addition to any fees charged by your student's school and must be paid directly to TCD. Fees are subject to change. By signing below you are agreeing to pay TCD's fees for your student to attend here.

This electronic signature as its related fields are treated like a handwritten signature on a paper form.

Parent/Guardian - I affirm that the information provided is true, correct, and complete to the best of my knowledge and belief.

Parent/guardian - please type your name in the box above as your electronic signature.

Counselor Verification Code:

Counselors, please use the verification code that was sent to you.

TCD 2025-2026 Registration Form

This form must be completed by students with their parent(s)/guardian(s).

Student Demographic Information

TCD Program Selection

Student Medical Information

Parent/Guardian Contact Information

Emergency Contacts

Student Questions

Student & Parent/Guardian Agreements

Counselor Section