Careers Electric Registration Form

Careers Electric™ Summer Academy
Registration

Student's Name

First NameLast Name

Student's Email Address

Student's Birthdate (Student must be 16 years of age by May 20, 2026 to be eligible)

MonthDayYear

Student's School

Student's Grade Level

What makes you interested in electrical work?

Why should we select you for this program?

Please provide the contact info of a parent/guardian of the student.

Parent/Guardian's Name

First NameLast Name

Parent/Guardian's Email Address

Parent/Guardian's Phone Number

Enter phone number.Format: (000) 000-0000.

Do you require any ADA accommodations?

Please review the form, then click the submit button below.

Reply To Email

example@example.com

Sender Name