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Student Application (Test)

Student Application (2020-2021)

Step 1 of 5

20%

STEP 1: Personal Info
Student Information
Name*
First Last
Email*
Use your OFFICIAL SCHOOL EMAIL ADDRESS if available.
Cell Phone*
Address*
Street Address Address Line 2 City State ZIP Code
Date of Birth*
MM slash DD slash YYYY
Parent / Guardian Information
Name*
First Last
Relationship to Student*
Email*
Cell Phone*
Home Phone

STEP 2: Educational Background
High School Type*
If other, please specify:*
High School Name*
If other, please list name here:*
Grade Level*
- 11 (Junior)
- 12 (Senior)
List any CTE course you are taking/have taken at your current high school:
Please list the name and the year of the course [e.g., Robotics (Fall 2018), 3D Modeling & Animation (Spring 2019), etc.]

STEP 3: Interests & Career Information
Education plans after high school?*
(Check all that apply)
- Apprenticeship
- 2-Year Degree
- 4-Year Degree
Are you available for a Pre-Apprenticeship assignment from June to August?*
- Yes
- No
Which apprenticeship pathway(s) are you interested in?*
- Advanced Manufacturing
- Undecided
Why are you interested in this opportunity?*
List any school, athletic, volunteer, or community activities.

STEP 4: Employment History (if applicable)
Job #1
Place of Employment
Employment Address
Street Address Address Line 2 City State ZIP Code
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
First Last
Supervisor Phone
Description of Job Duties
Job #2
Place of Employment
Employment Address
Street Address Address Line 2 City State ZIP Code
Employment Start Date
MM slash DD slash YYYY
Employment End Date
MM slash DD slash YYYY
Supervisor Name
First Last
Supervisor Phone
Description of Job Duties

STEP 5: Program Requirements & Submission
Apprenticeship Program Information
How did you hear about RockATOP (Apprenticeship Program)?*
(Check all that apply)
- Career Development Coordinator
- School Counselor
- Career Coaches
- School Assembly Presentations
- Classroom Presentations
- Teacher
- Parent
- Friend
- Television
- Social Media (Facebook, YouTube, etc.)
- School Phone Message
- Other
If Other, please list here:
Is there any additional information you would like us to know when considering your application?
Have you submitted a RockATOP application before?*
- Yes
- No
Disclaimer
My signature below verifies that the above information is correct. I understand if I am selected for the program, I am responsible for abiding by the policies and procedures of my employer as well as the guidelines for the RockATOP program. I understand that I will be responsible for transportation to and from my work assignment. I understand that I must be eligible for work in the United States. I give permission for the RockATOP program and my employer to review my grades to verify that I am maintaining the standards set by this program.
Consent*
I agree to this policy.
Student Signature*
First Last
Date*
MM slash DD slash YYYY

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