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
Charles B. Aycock High SchoolEastern Wayne High SchoolEdgewood Community Developmental SchoolGoldsboro High SchoolRosewood High SchoolSouthern Wayne High SchoolSpring Creek High SchoolWayne Early/Middle College High SchoolWayne Middle/High AcademyWayne Preparatory AcademyWayne School of EngineeringWayne School of Technical ArtsOther
9th Grade10th Grade11th Grade12th Grade
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.
Yes, I need an accommodation.No, I do not need an accommodation.
Please review the form, then click the submit button below.
Reply To Email
example@example.com
Sender Name
Should be Empty: