WCCC Aquaculture Pre-Apprenticeship Program

Name*

First NameMiddle NameLast Name
WCCC Aquaculture Pre-Apprenticeship & Summer Work Program
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
County of Residence
Date of Birth*

MonthDayYear
Date
Phone Number*

Area CodePhone Number
E-mail*
Are you a resident of Maine?*

YesNo
Are you a US citizen?*

YesNo
Ethnic Group*

Not Hispanic/LatinoHispanic/Latino
Race*

American Indian or Alaska NativeAsianBlack or African AmericanWhiteNative Hawaiian or Other Pacific Islander
Gender*

MaleFemaleOther
Education (highest grade completed)*

Less than HS Diploma/GED/ or HiSetHS Diploma, GED, or HiSetSome college/no credentialAssociate's degreeBachelor's degreeMaster's degree of higher
Do you have transportation?*

YesNo
Are you currently employed?*

YesNo
If Yes, who is your employer?*
If so, are you currently employed part-time?*

YesNo
How did you hear about this course?*

SchoolEmailFacebookWord of MouthOther
Do you agree to receive SMS text messages regarding the course?

YesNo
I certify that all information on this application is accurate and complete.
Signature*
Should be Empty:

WCCC Aquaculture Pre-Apprenticeship & Summer Work Program