IEC-KYIN Apprenticeship Program Enrollment Form
Basic Information
Name
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Gender
*
Please Select
Male
Female
Race
*
Please Select
Caucasian
African American
Asian
Hispanic
In which year are you enrolling?
*
Please Select
Mid-Year
Enrollment for all classes other than Mid-Year are closed.
Employer/Company
*
Please provide the name of your sponsoring contractor company. We will contact them to verify their sponsorship.
Personal Contact Information
Email
*
Please provide an active email address which you check regularly. This will be the primary way that IEC contacts you with relevant class information.
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Additional Information
Have you ever been or are you associated with any other electrical Apprenticeship programs other than the IEC?
*
Yes
No
If yes, which programs?
Have you ever previously attended the IEC of Kentucky and Southern Indiana's Apprenticeship Program?
*
Yes
No
What dates did you attend this previous program?
*
ex: August 2019- May 2021
Have you obtained a high school diploma or GED?
*
Yes
No
Which did you obtain?
High School Diploma
GED
Name and City of High School Attended:
*
Enter "not applicable" if you did not attend high school or if you completed a GED
In what year did you graduate high school/complete your GED?
*
Did you attend a vocational/technical program while in high school?
*
Yes
No
Do you have a college degree?
Yes
No
If yes, what was your degree in?
Do you qualify for VA benefits?
*
Yes
No
Do you have any physical disabilities that would necessitate accommodations?
*
Yes
No
Did you have an IEP, 504 Plan, or equivalent while in high school?
*
Yes
No
Please upload a clear photo copy of your drivers license.
*
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Do you currently hold an Electrical License?
*
Yes
No
Please inform us of any additional information we should take into account with your enrollment. (ex. active military service, out-of-town work, etc)
Please sign to verify that the information provided here is true to the best of your knowledge, and that submission of this form does not guarantee enrollment in the 2024-25 school year - enrollment is not complete until employer sponsorship is verified and book and admin fees have been paid.
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Date
*
-
Month
-
Day
Year
Date
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