Culinary Program Interest Form "*" indicates required fields Prospective Student Name* First Middle Last Support Person NameIf seeking this information on behalf of the student First Middle Last I am:* A parent seeking information for my child. An agency seeking information for my client. A prospective student seeking information for myself. Other Email* Primary Phone*Preferred Contact Method Email Phone How did you hear about The Culinary Program?* Family/Friend/Word of Mouth Social Media Community Agency Other Contact & Demographic InformationDate of Birth* MM slash DD slash YYYY What county do you live in?* Anne Arundel Calvert Charles Prince George's St. Mary's Are you currently in school?* Yes No If yes, which school?* Which timeframe best describes your general availability to attend classes?* Mornings (approximately 9AM - Noon) Afternoons (approximately 12 - 3PM) Late Afternoon (3PM - 6PM) Do you have reliable transportation?* Yes No Disability InformationPlease list and describe your disabilities, beginning with your primary disability.Disability #1: What is the disability?* Disability #2: What is the disability? Disability #3: What is the disability? Additional CommentsPotential Student AgreementStudent Attributes for Admission & Success*Personal: Self-care: Each student is responsible for their own self-care, including but not limited to personal hygiene and maintaining a clean uniform and professional appearance. (We will study this further in ServSafe Food Handling.); Self-control: The ability to self-monitor and self-regulate behavior, use appropriate language and actions as well as avoid inappropriate outbursts; Able to communicate with others and express needs; Able to handle changes in routine and can be flexible in fluctuating circumstances; Able to self-administer medications. Social-Emotional: Workplace appropriate behavior: Applicant must be able to appropriately self-regulate and be aware of his/her own actions in relation to those around them; Respect: Students must show respect for self and others; Able to work in a team as well as individually; Remain organized during tasks and classwork; Self-Management and motivation; Manage assigned tasks with limited reminders; Effectively manage mild stress. (e.g. time demands, constructive criticism and coaching) Cognitive: Cognitive skills sufficient to function in a kitchen and learning environment; Ability to understand basic instructions and carry out those instructions, consistently with low to moderate supervision; Comprehend written text at a 5th grade level; Read and follow basic recipes and directions, including the transfer to action; Ability to recognize a hazardous/unsafe situation/environment and act upon it appropriately; Reasoning sufficient to understand a critique and/or constructive criticism; Sustained attention to workload over time and goal achievement Vocational: The student has the desire and motivation to participate in a pre-vocational educational experience; Willing to learn about and use commercial kitchen equipment such as mixers, gas stoves, hoods, convection ovens, and dishwashers; Can use basic technology (cell phone, laptop, etc.) I agree that I have read the Student Attributes for Admission and Success.PhoneThis field is for validation purposes and should be left unchanged. Δ