ProStart Pre-Apprenticeship Participant Enrollment Form

ProStart Pre-Apprenticeship Participant Enrollment Form
PROGRAM INFORMATION:

Pre-Apprenticeship name: PA ProStart Culinary/Hospitality Program
Pre-RA Program Sponsor: PRLAEF
Occupations: Line Cook, Kitchen Manager, Restaurant Manager
Program Sector: Hospitality/Tourism
Total Program Hours: Competency Based
Registered Apprenticeship Sponsor Partner: NRAEF
RAPIDS Program Sponsor Partner Number: 2017-ZA-68465
TO BE COMPLETED BY STUDENT:

Contact Information
Phone Number*
Please enter a valid phone number.
Email Address*
example@example.com
Parent/Guardian Email Address (optional)
example@example.com
Residence - Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Current School Status
School/Program Name*
Please indicate which CTE or CTC program you are associated with.
Current Grade*
What is the highest level of education you have completed?*

Employment Status
Are you currently employed?*

Yes, employedYes, employed, but received notice of terminationNo, unemployed (seeking employment)No, not in the labor force (not seeking a job)
If you selected "Yes, employed", what is your employer and current position?
Employer Name
Current Position

Criminal Background
Have you ever been engaged in the juvenile justice/criminal justice system (misdemeanor or felony)?*

YesNoDecline to answer

Veteran Status
Are you a U.S. military Veteran?*

YesNoDecline to answer

Disability
Do you have a disability and/or receive special education/IEP services:*

YesNoDecline to answer

Agreement & Consent Form
PRE-APPRENTICESHIP AGREEMENT:

By signing below, I agree to participate in the Pre-Apprenticeship Program, and I understand my responsibilities.
Participant Signature*

Clear
DATA CONSENT FORM:

CLICK HERE to sign the data consent form.

If under 18, please have a parent/guardian sign.
Should be Empty: