FY24 Imagine U Intern Application Form

Imagine U Intern Application Form
The Imagine Institute

16000 Christensen Rd Suite 201

mentors@imaginewa.org

www.imaginewa.org
Please complete this application for Imagine U, a mentorship program that will support you on your path to becoming a licensed child care provider. The Imagine U program is designed exclusively for individuals who are committed to:
- Opening their own licensed family child care business
- Enrolling at least one child who receives a Wasington State child care subsidy
- Interested in gaining additional technology support through the licensing process
- Have a commitment to racial equity
Applicants will be notified of next steps for the Imagine U program on or before June 30th.

Read and follow the instructions carefully prior to submitting your application.
I. Personal Data

Tell us about yourself
Full Name*

First NameLast Name
Phone Number*
Email *
Where the confirmation will be sent to
Home Address*

Street Address

Street Address Line 2

CityState

Zip Code
What languages are you comfortable communicating in? (Select all that apply)*

EnglishSpanishSomaliArabicNone of the above
Do you currently live in the home where you plan to open your child care?*

YesNoNo, but I have secured housing and will move soon

III. Program Expectations
Are you available to attend mandatory trainings on either weeknights, Saturdays or Sundays?*

YesNo
Are you available to participate in weekly calls as needed?*

YesNo
Are you available to work at least 20 hours per month in your mentor's child care?*

YesNo
Do you have a preferred mentor you wish to work with?*

YesNo
Mentor Information

IV. ECE Substitute Pool
Are you an approved Early Care and Education substitute?*

YesNo
How many shifts have you worked as an ECE substitute?*

0 - 5 shifts6 - 10 shifts11 + shifts
Are you planning on continuing your work as a substitute throughout your participation in the Imagine U program?*

YesNo

VII. Submission
Program Eligibility: The Imagine Institute does not discriminate in any program or activity on the basis of race, color, religion, gender, age, national origin, disability, marital status, or any other protected class.
By signing the space below, you are certifying that all information is correct and that you are the person completing this application. When you press the submit button, you will receive an email confirmation that your application was received. Please print for your records and retain as verification of your application.
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Imagine U Intern Application Form