Artificial Intelligence Academy Application

Application for the Artificial Intelligence Academy (AIA)
Thank you for your interest in the AI Academy.

We are pleased that you are considering the AIA as the next step in your professional journey. Our application will gather important information on your background, education, and experiences that our program staff will use to determine your admission to the program. Additionally, some data are required in order to complete our reporting requirements to the funding agency of the AIA. Please answer each of the questions as fully as possible.

If you have any questions that arise as you are completing the application, email our program staff at aiacademyinfo@ncsu.edu and someone will get back with you as soon as possible. We look forward to reviewing your materials.
Name *

First Name Last Name
E-mail *
example@example.com
Phone Number *
Address *

Street Address

Street Address Line 2

City State

Zip Code
Are you willing to relocate for your apprenticeship placement in the program? *

Yes No

Thank you for your interest in the Artificial Intelligence Academy!

The U.S. Department of Labor requires all participants to be U.S. citizens or have permanent legal residency. We regret to inform you that, based on your citizenship/residency status, you will not be able to participate in the AI Academy. Please close out of this survey. We wish you all the best in your pursuit of a career in AI.

Interest in A.I. Academy
The programming is the same for each Cohort, the only difference is the actual start date. The program is 20 weeks from start date to complete the Basic Pathway (first two courses) and 40 weeks total of programming from start to complete both the Basic Pathway and Advanced Pathway (all four courses).
Please select your top two choices of AI Academy Cohorts you are interested in joining (list your first preference, followed by your second preference). *
Were you recruited to apply for the AI Academy? *

Yes No
Who recruited you to apply for the AI Academy? *

FASTPORT VetsInTech NC State University Other
Why are you interested in participating in this program? (suggested 2-3 paragraphs) *

Education Information
What is the highest level of degree obtained? *

Attained secondary school diploma Attained a secondary school equivalency I am a participant with a disability and received a certificate of attendance/completion as a result of successfully completing an Individualized Education Program (IEP) Completed one or more years of postsecondary education Attained a postsecondary technical or vocational certificate (non-degree) Attained an Associate's degree Attained a Bachelor's degree Attained a degree beyond a Bachelor's degree No Educational Level Completed
At what college/university/institution did you complete your highest level of degree? *
What is/was your major for your highest level of degree? *
List up to 15 completed courses related to Computer Science and/or Artificial Intelligence. Click "Save" after typing in each course for another text box to appear.

Educational Programs
Are you participating in postsecondary education during program participation? *

Yes, I am participating in a postsecondary education program during the program that will lead to a credential or degree. No, I am not participating in a postsecondary education program during the program that will lead to a credential or degree.
Note: The participation in the postsecondary education program must be one that is expected to lead to a credential or degree from an accredited postsecondary education institution at any point during program participation.
Please describe the other educational program in which you are currently enrolled. *
What is the end date for the other educational program in which you are currently enrolled? (mm/dd/yyyy) *

Month Day Year
Date
Have you ever participated in an internship and/or apprenticeship program previously? *

Yes No
Please describe your previous internship and/or apprenticeship program experience. *
Are you currently an intern or apprentice for any other program? *

Yes No
Please describe your current intern or apprentice experience. *
What is the end date of your current intern or apprentice experience? (mm/dd/yyyy) *

Month Day Year
Date

About You
In 150 words or less, please tell us about yourself. *

0/150
List any professional organizations or associations you've belonged to, separated by commas.

References
Please provide the contact information for three references: one employer/supervisor, one co-worker, and one personal.
Reference One Name *

First Name Last Name
Reference One Email *
example@example.com
Reference One Phone Number *
In what capacity does Reference One know you? *
What type of reference is Reference One? *

Employer/Supervisor Co-Worker Personal
Reference Two Name *

First Name Last Name
Reference Two Email *
example@example.com
Reference Two Phone Number *
In what capacity does Reference Two know you? *
What type of reference is Reference Two? *

Employer/Supervisor Co-Worker Personal
Reference Three Name *

First Name Last Name
Reference Three Email *
example@example.com
Reference Three Phone Number *
In what capacity does Reference Three know you? *
What type of reference is Reference Three? *

Employer/Supervisor Co-Worker Personal

Required Reporting Fields
The following questions ask for additional data that is needed for us to complete our report to the U.S. Department of Labor. Answers to these questions will not impact your application. If you have any questions that arise as you are completing these questions, email our program staff at aiacademyinfo@ncsu.edu and someone will get back with you as soon as possible.
Do you have a disability? *

Yes No Choose not to report
Note: "Disability" as defined in Section 3(2)(a) of the Americans with Disabilities Act of 1990 (42 U.S.C. 12102), is a physical or mental impairment that substantially limits one or more of the person's major life activities.

Are you an eligible veteran or other eligible person? *

Yes, I served in the active U.S. military, naval, or air service for a period of less than or equal to 180 days, and was discharged or released from such service under conditions other than dishonorable. Yes, I served on active duty for a period of more than 180 days and was discharged or released with other than a dishonorable discharge; or was discharged or released because of a service connected disability; or as a member of a reserve component under an order to active duty pursuant to section 167(a), (d), or (g), 673 (a) of Title 10, U.S.C., served on active duty during a period of war or in a campaign or expedition for which a campaign badge is authorized and was discharged or released from such duty with other than a dishonorable discharge. Yes, I am (a) the spouse of any person who died on active duty or of a service connected disability, (b) the spouse of any member of the Armed Forces serving on active duty who at the time of application for assistance under this part, is listed, pursuant to 38 U.S.C 101 and the regulations issued there under, by the Secretary concerned, in one or more of the following categories and has been so listed for more than 90 days: (i) missing in action; (ii) captured in the line of duty by a hostile force; or (iii) forcibly detained or interned in the line of duty by a foreign government or power; or (c) the spouse of any person who has a total disability permanent in nature resulting from a service connected disability or the spouse of a veteran who died while a disability so evaluated was in existence. No, I do not meet any of the conditions describe above.

Criminal justice history. *

I am a person who either (a) has been subject to any stage of the criminal justice process for committing a status offense or delinquent act, or (b) requires assistance in overcoming barriers to employment resulting from a record of arrest or conviction. I do not meet any one of the conditions described above. Choose not to report

Do you qualify for low income status at program entry? *

Yes, I qualify for low-income status at program entry. No, I do not meet any of the criteria presented above.
Note: "Low-income status" is defined as, at program entry, you are a person who:
- (a) Receives, or in the 6 months prior to application to the program has received, or is a member of a family that is receiving or in the past 6 months prior to application to the program has received:
  - (i) Assistance through the supplemental nutrition assistance program (SNAP) under the Food and Nutrition Act of 2008 (7 USC 2011 et seq.);
  - (ii) Assistance through the temporary assistance for needy families program under part A of Title IV of the Social Security Act (42 USC 601 et seq.);
  - (iii) Assistance through the supplemental security income program under Title XVI of the Social Security Act (42 USC 1381); or
  - (iv) State or local income-based public assistance.
- (b) Is in a family with total family income that does not exceed the higher of the poverty line or 70% of the lower living standard income level;
- (c) Is an individual who receives, or is eligible to receive a free or reduced price lunch under the Richard B. Russell National School Lunch Act (42 USC 1751 et seq.);
- (d) Is a foster child on behalf of whom State or local government payments are made;
- (e) Is an participant with a disability whose own income is the poverty line but who is a member of a family whose income does not meet this requirement;
- (f) Is a homeless participant or a homeless child or youth or runaway youth; or
- (g) Is a youth living in a high-poverty area.

Are you an English Language Learner at program entry? *

Yes, I am an English Language Learner at program entry. No, I do not meet any of the criteria presented above.
Note: "English Language Learner" is defined as, at program entry, you are a person who:
- has limited ability in speaking, reading, writing or understanding the English language and also meets at least one of the following two conditions :
  - (a) your native language is a language other than English, or
  - (b) you live in a family or community environment where a language other than English is the dominant language.

What is your employment status as of the time of program entry? *

At program entry, I am (a) currently performing any work at all as a paid employee, (b) currently performing any work at all in my own business, profession, or farm, (c) currently performing any work as an unpaid worker in an enterprise operated by a member of the family, or (d) one who is not working, but currently have a job or business from which I am temporarily absent because of illness, bad weather, vacation, labor-management dispute, or personal reasons, whether or not paid by the employer for time-off, and whether or not seeking another job. At program entry, I, although employed, either (a) have received a notice of termination of employment or the employer has issued a Worker Adjustment and Retraining Notification (WARN) or other notice that the facility or enterprise will close, or (b) am a transitioning service member (i.e., within 12 months of separation or 24 months of retirement). At program entry, I am not in the labor force (i.e., those who are not employed and are not actively looking for work, including those who are incarcerated). At program entry, I am not employed but am seeking employment, making specific effort to find a job, and available for work.

Have you been unemployed for 27 or more consecutive weeks at the time of program entry? *

Yes, I have been unemployed for 27 or more consecutive weeks at the time of program entry No, I have not been unemployed for 27 or more consecutive weeks at the time of program entry

Are you a dislocated worker? *

Yes, I am a dislocated worker. No, I do not meet any of the above criteria.
Note: "Dislocated worker" is defined as a person who:
- (A)
  - (i) has been terminated or laid off, or who has received a notice of termination or layoff, from employment;
  - (ii)
    
    (I) is eligible for or has exhausted entitlement to unemployment compensation; or
    
    (II) has been employed for a duration sufficient to demonstrate, to the appropriate entity at a one-stop center referred to in section 121(e), attachment to the workforce, but is not eligible for unemployment compensation due to insufficient earnings or having performed services for an employer that were not covered under a State unemployment compensation law; and
  - (iii) is unlikely to return to a previous industry or occupation;
- (B)
  - (i) has been terminated or laid off, or has received a notice of termination or layoff, from employment as a result of any permanent closure of, or any substantial layoff at, a plant, facility, or enterprise;
  - (ii) is employed at a facility at which the employer has made a general announcement that such facility will close within 180 days; or
  - (iii) for purposes of eligibility to receive services other than training services described in WIOA Sec 134(c)(3), career services described in WIOA Sec 134(c)(2)(A)(xii), or supportive services, is employed at a facility at which the employer has made a general announcement that such facility will close;
- (C) was self-employed (including employment as a farmer, a rancher, or a fisherman) but is unemployed as a result of general economic conditions in the community in which the participant resides or because of natural disasters;
- (D) is a displaced homemaker; or
- (E)
  - (i) is the spouse of a member of the Armed Forces on active duty (as defined in section 101(d)(1) of title 10, United States Code), and who has experienced a loss of employment as a direct result of relocation to accommodate a permanent change in duty station of such member; or
  - (ii) is the spouse of a member of the Armed Forces on active duty and who meets the criteria described in WIOA Section 3(16)(B).

Are you enrolled in a secondary education program at or above the 9th grade level? *

Yes, I am enrolled in a secondary education program at or above the 9th grade level. No, I am not enrolled in a secondary education program at or above the 9th grade level.
Note: A Secondary Education Program includes both secondary school and enrollment in a program of study with instruction designed to lead to a high school equivalent credential. Examples may include adult high school credit programs and programs designed to prepare participants to pass recognized high school equivalency exams such as the GED, HiSET, or TASC. Programs of study designed to teach English proficiency skills or literacy skills below the 9th grade equivalent are not considered Secondary Education Programs.

This also applies if you were either already enrolled in education or training at the time of application to the program OR became enrolled in an education or training program at or above the 9th Grade level at any point while participating in the program.

Are you an underemployed worker? *

Yes, I am an underemployed worker. No, I am not an underemployed worker.
Note: "Underemployed worker" is defined as a person that is not currently connected to a full-time job commensurate with the individual’s level of education, skills, or wage and/or salary earned previously, or who have obtained only episodic, short-term, or part-time employment.

Social Security Number
This is only used for reporting purposes as required by the U.S. Department of Labor. Please enter numbers only, no dashes or spaces.

Consent and Submission
Please sign below to indicate the information presented in this application is accurate to the best of your knowledge and that you consent to providing this information to the AI Academy for program administration and required reporting purposes. *

Clear
Signature Date *

Month Day Year
Date
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Application for the Artificial Intelligence Academy (AIA)

Demographics

Thank you for your interest in the Artificial Intelligence Academy!

Interest in A.I. Academy

Education Information

Educational Programs

Career Information

Military Information

Credentials

About You

References

Required Reporting Fields

Consent and Submission