Early Educators Apprenticeship Application
Apply to the Early Educators Apprenticeship Program for an opportunity to earn 12 ECE units, earn your early childhood teaching permit, and become an early childhood teacher!
First Name: *
Middle Initial:
Last Name: *
Best phone number to reach you: *
Best E-mail to reach you: *
Mailing Address: Stree, City, State, Zipcode: *
How did you hear about the Apprenticeship Program? *
Are you authorized to work in the United States? *
Full Social Security Number: XXX-XX-XXXX *
Are you at least 18 years old? *
Gender:
Clear selection
Race and Ethnicity:
Clear selection
Hispanic Status:
Clear selection
What is the primary language you speak at home?
Personal Education Level:
Clear selection
School Name/ Location
Major/ Area of Study: (if applicable)
Degree Type: (if applicable)
Total Units Completed: (if applicable)
What is the highest level of Early Childhood Education or Development Education you have received?
Clear selection
Child Development Permit Type: (if applicable)
Clear selection
Permit Expiration Date: (if applicable)
MM
/
DD
/
YYYY
Which program Tier are you applying to (Check all that apply):
Are you currently employed? *
If "Yes," Name of your employer/ Type of Business:
If you are working do you have time to do filed placement hours?
Clear selection
If you are currently unemployed, do you wish to be employed?
Clear selection
If you have worked in the YMCA before, list location, date, and position:
What services do you need to participate successfully in the program? (Check all that apply)
Have you received CalWORKs or CalFresh in the last 24 months? *
If yes, what county?
Do you have child(ren); *
If yes, what is/are the date(s) of birth:
If you have child(ren) do you have child care for your child(ren)? If so, where?
Why do you want to be in the Head Start Apprenticeship Program?
What is your professional goal - where do you see yourself in 1 to 3 years from now?
List three persons not related to you who would have knowledge of your work performance within the last three years. Please include Name and Contact Information (i.e. email and phone number)
Signature (Name) and Date: I hereby certify that the information furnished on this application is accurate and complete to the best of my knowledge. I understand that if I have knowingly misrepresented my academic qualifications, the consequences of any misrepresentation on my application may result in denial of admission, rescinding of admission, suspension, and expulsion. I agree that if admitted I will abide by the rules and regulations of the university and Head Start Apprenticeship program. *
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