Youth Apprenticeship Application

Personal Information

Enter in basic personal information we can use to identify you.

First Name

Last Name

Birthday

Gender

Race

Hispanic/Latino

Phone Number

School Email This will be the email address you use to login to the application.

Password Password must be 8 characters long, and include 1 special character (!, @, $, #...)

Confirm Password Please confirm the password.

Address (Line 1)

Address (Line 2)

City

State

County

Zip

Student Information

Enter in student and school information.

School District

Youth Apprenticeship Program Area

Grade Level

Expected Graduation Year

Counselor

Do you have a valid driver's license?

Yes

Do you have a reliable form of transportation to and from work?

Yes

Do you have valid vehicle insurance coverage?

Yes

Parent/Guardian Information

Enter in basic parent/guardian information.

Parent/Guardian First Name

Parent/Guardian Last Name

Parent/Guardian Email

Employer Mentor Information

Please provide name and contact information for your Youth Apprenticeship Employer Mentor (if known).

Youth Apprenticeship Business Name

Mentor First Name

Mentor Last Name

Mentor Email

What are your duties at your job?

I understand this is not a summer-only program and that 250 of my 450 work hours per year must be concurrent with my related instruction.

I understand that CESA 5 does not discriminate against any applicant on the basis of sex, sexual orientation, race, national origin, ancestry, color, age, creed, religion, pregnancy, marital or parental status, or physical, mental, emotional or learning disability, arrest record, conviction record, military participation, use or non-use of lawful products off the employer's premises during non-working hours, or any other reason prohibited by state or federal law.