Apprenticeship Interest Form

Thank you for showing interest in our Apprenticeship Program. After completing the form, a member of our staff will contact you to determine your eligibility.

Are you completing this form on behalf of someone else? *

What is your position? *

Program Information

*Please note that the Apprenticeship Program is employer driven and requires the apprentice to have access to an onsite coach with whom they are employed with.

Program Name *

Program Address *

Program City *

Program State *

Program Zip Code *

Program County *

Program Phone *

STAR Level *

Age Group(s) You Serve *

Infant

Toddler

Pre-k

Kindergarten

School Age

Adults

None of the Above

Director Name *

Director Email *

Director Phone *

Choose all that apply:

Pre-K Counts

Head Start

Early Head Start

NAEYC Accreditation

Family Child Care

Coach Name *

Apprentice Applicant Information

First Name *

Last Name *

Email *

Phone *

Race and Ethnicity *

Gender *

Do you have a high school diploma or GED? *

Address Line 1 *

Address Line 2 *

City *

County *

Zip *

State/Province *

This form is intended for individuals who live in Pennsylvania. Do you live in the state of Pennsylvania? *

Pennsylvania PD Registry Number *

Apprentice Education Information

Have you previously obtained college credits? *

Are you currently working in early education? *

Number of years working in the early childhood field? *

Do you have access to reliable internet/Wi-Fi and an electronic device? *

What is your highest level of educational attainment? *

Would technology be a barrier for completing coursework or attending online classes? *

Use this space to tell us more about any questions or thoughts you may have.

How did you hear about this?

Flyer/Brochure

Social Media

Trying Together Newsletter

Trying Together Staff

Trying Together Website

Online Search

Friend/Colleague

Another Organization

Other

Data Privacy & Consent

Email

SMS/MMS