Culinary Program Interest Form
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Prospective Student Name
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First
Middle
Last
Support Person Name
If seeking this information on behalf of the student
First
Middle
Last
I am:
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A parent seeking information for my child.
An agency seeking information for my client.
A prospective student seeking information for myself.
Other
Email
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Primary Phone
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Preferred Contact Method
Email
Phone
How did you hear about The Culinary Program?
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Family/Friend/Word of Mouth
Social Media
Community Agency
Other
Contact & Demographic Information
Date of Birth
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MM slash DD slash YYYY
What county do you live in?
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Anne Arundel
Calvert
Charles
Prince George's
St. Mary's
Are you currently in school?
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Yes
No
If yes, which school?
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Do you have reliable transportation?
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Yes
No
Disability Information
Please list and describe your disabilities, beginning with your primary disability.
Disability #1: What is the disability?
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Disability #2: What is the disability?
Disability #3: What is the disability?
Additional Comments
Potential Student Agreement
Student Attributes for Admission & Success
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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.
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