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There is a cap of $300 per applicant. Apprentices are eligible for two calendar years from their date of initiation but may only apply once.
Northern Nevada Member Assistance Program Registration Form
Participant Information
Apprentice Name:
Birth Year:
Gender:
Phone:
Email:
example@example.com
Address / City / Zip:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Contact Method:
Call
Text
Email
Ethnicity
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Middle Eastern or North African (MENA)
Native Hawaiian or Pacific Islander
White
Other/ Mixed Race
Other
Apprenticeship Verification
Trade / Local:
Training Center / JATC:
Please Select
Bricklayers BAC13
Construction Craft Laborers LIUNA169
Electricians IBEW401
Elevator Constructors IUEC8
Heat and Frost Insulators Local 16
Ironworkers IW118
Nevada Energy IBEW1245
Operating Engineers OE3
Painters/Allied Trades IUPAT567
Plasterers/Cement Masons OPCMIA797
Plumbers/Pipefitters UA350
Sheet Metal SMART26
Apprentice Year (If organized)
1st
2nd
3rd
Other:
Start Date / Cohort:
Pathway to your apprenticeship: (check all that apply)
MC3 (County School District)
Workforce Development
NNLC
Youth build program
Reentry
Children's cabinet
Referral/Walk-in
Organized:
Other
Submit completed form with or without PASS application to:
PASS@nnvmap.org
Confidential - NNVMAP internal use only
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Submit
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