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ApprenticeShift Registration Form
Location: 3845 Raleigh Millington Rd. Memphis, TN 38128
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Student Name *
Student's Phone Number *
Student's Address (include zip code) *
Student's Email *
DOB *
MM
/
DD
/
YYYY
Gender *
School Attending  *
What is your career goal? *
What career training are you signing up for? *
If career training is other please advise. *
I authorize UniverCity 360 to access and use my academic and social progress information related to the activities I participate in during the school year.  This information may be reported to all program funders for the purpose of demonstrating the effectiveness of UniverCity 360's initiatives. *
Do you give UniverCity permission to take photos, film videos and release the content on its website and social media platforms? *
Do you need any additional resources? If so, please explain. *
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