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Early Childhood Pre-apprenticeship Application
Spring 2022. Please complete this application as thoroughly as possible. It will be shared with employers.
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* Indicates required question
Last Name
*
Your answer
First Name
*
Your answer
Middle Name
*
Your answer
High School
*
Choose
East Surry High School
Elkin High School
Forbush High School
Mount Airy High School
North Surry High School
Starmount High School
Surry Central High School
Surry Early College High School
Surry Online Magnet School
Yadkin Early College
Current Grade Level
*
Junior
Senior
Super Senior (Early College only)
Other:
Student Cell Phone Number
*
Your answer
Your Email (list one you check frequently)
*
Your answer
Student Full Address (include town and zip code)
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Languages Spoken
*
Your answer
Current Grade Point Average
*
Your answer
Current number of absences at school
*
Your answer
Are there any times or days you will NOT be able to work at your pre-apprenticeship?
*
Your answer
Have you enrolled in, completed, or plan to enroll in EDU 119?
*
Choose
Currently enrolled
Plan to enroll Spring 2023
Completed and have credit for EDU 119 already
Have you taken any other early childhood classes (at your high school &/or community college)? If so, please list them.
Your answer
If you have had any discipline referrals (in or out of school suspension), please give the dates and reasons.
Your answer
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