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WISCONSIN YOUTH APPRENTICESHIP Interest Survey Please complete the application electronically using Microsoft Word . Date: Click here to enter a date. Put an “X” next to the Youth Apprenticeship you are considering: Arts/AV Com. Graphic Tech. Architecture/Construction Financial Services Hospitality/Tourism Information Technology Manufacturing Health Science Pathway: Dietary Aide Level 1 Nursing Assistant Pharmacy Technician STEM: Drafting, Design, Engineering Transportation BACKGROUND INFORMATION Student Name: Click here to enter text. Address: Click here to enter text. City: Click here to enter text. Zip: Click here to enter text. Home Phone: Click here to enter text. Date of Birth: Click here to enter a date. School Name: Click here to enter text. Student ID: Click here to enter text. Grade Level in School: Click here to enter text. Current Grade Point Average: Click here to enter text. Email Address: Click here to enter text. Cell Phone Number: Click here to enter text. Transportation/Availability: Do you hold a valid driver’s license? Choose an item. If yes, do you have access to and use of a car? Choose an item. Page 1 of 2

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WISCONSIN YOUTH APPRENTICESHIP Interest Survey

Please complete the application electronically using Microsoft Word. Date: Click here to enter a date.

Put an “X” next to the Youth Apprenticeship you are considering:

☐ Arts/AV Com. Graphic Tech. ☐ Architecture/Construction ☐ Financial Services

☐ Hospitality/Tourism ☐ Information Technology ☐ Manufacturing

Health Science Pathway:☐ Dietary Aide ☐ Level 1 Nursing Assistant ☐ Pharmacy Technician

☐ STEM: Drafting, Design, Engineering ☐ Transportation

BACKGROUND INFORMATION

Student Name: Click here to enter text.

Address: Click here to enter text. City: Click here to enter text. Zip: Click here to enter text.

Home Phone: Click here to enter text. Date of Birth: Click here to enter a date.

School Name: Click here to enter text. Student ID: Click here to enter text.

Grade Level in School: Click here to enter text. Current Grade Point Average: Click here to enter text.

Email Address: Click here to enter text. Cell Phone Number: Click here to enter text.

Transportation/Availability:Do you hold a valid driver’s license? Choose an item.

If yes, do you have access to and use of a car? Choose an item.

If no, describe how you will get to and from work. Click here to enter text.

Page 1 of 1

Please email interest survey to Terri Salzer: [email protected]

OR turn in to your school’s Career Champion.