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Program Registration and Apprenticeship AgreementAugust 12th, 2021
APPRENTICE AGREEMENT AND REGISTRATION – SECTION II OMB No. 1205-0223 Expiration Date: 06/30/2024 PART A: APPRENTICE’S INFORMATION 1. First Name Last Name Middle Name (Optional) Suffix (Optional) Address (No., Street, City, State, Zip Code) Telephone Number (Optional) E-mail Address (Optional) *Social Security Number - - Answer Both 4a. and 4b. below 4. a. Ethnicity (Select One) Hispanic or LatinoNot Hispanic or Latino Participant Did Not Self-Identify b. Race (Select One or More) American Indian or Alaska Native AsianBlack or African American Native Hawaiian or other Pacific Islander White Participant Did Not Self-Identify 5. Veteran Status (Select All That Apply) Non Veteran VeteranNon Veteran, Other Eligible IndividualVeteran, Eligible Participant Did Not Self-Identify 6. Education Level (Select One)Not High School graduate High School graduate(including equivalency) Some College or Associate’s degreeBachelor's degree Master’s degreeDoctorate or professional degree 2. Date of Birth (
