Pre-Apprentice Intake Form (Other) Apprenticeship Programs at SUNY

This form is to provide SUNY with details on participants that will be served by Apprenticeship Programs at SUNY. This form must be completed in its entirety as an incomplete form cannot be saved and returned to at a later time. Please forward questions or request for additional information to: apprenticeship@suny.edu.


SUNY FOLLOWS OCCUPATION TRADE TITLES AMONG ADVANCED MANUFACTURING, HEALTH CARE/HUMAN SERVICES AND OTHER (EXCLUDING CONSTRUCTION) SECTORS. PLEASE ENSURE YOU ARE COMPLETING THE CORRECT FORM THAT ALIGNS WITH THE SECTOR AND TRADE TITLE.

 

Please note, all dates will be entered as YYYYMMDD with no "/" or "-" between the numbers.

 

Select agreement number in the dropdown.


There is a search option available to locate appropriate agreement number

 

Do not use all capital letters.

 

Do not use all capital letters.

 
 
 

Enter the basic five-digit code only. Do not use the zip+4 format. (i.e. 12077 or 13501)

 
 

The purpose of this disclosure is to assist SUNY and its Partner Agencies in obtaining and reporting required information, including wage and employment data, to track the long-term success of this program. Your personal information is kept confidential and secure.


Although you cannot be denied service for failure to provide your Social Security Number, we strongly encourage you to do so in order to enable the project to quantify specific employment-related outcomes.


Enter number in the following format with no dashes 333224444. If you elect not to submit your social security number please enter 999999999.

 

If participant does not live in NYS select region where the college is located.


Regional map

 

1- Yes

0- No

 

Enter phone number in the following format 555-555-5555. If number not available please enter N/A.

 

If no email address please enter N/A.

 

Enter as YYYYMMDD.

 

1-Yes 0-No 9-Participant Did Not Self Identify

 

1-Yes 0-No 9-Participant Did Not Self Identify

 

1-Yes 0-No 9-Participant Did Not Self Identify

 

1-Yes 0-No 9-Participant Did Not Self Identify

 

1-Yes 0-No 9-Participant Did Not Self Identify

 

1-Yes 0-No 9-Participant Did Not Self Identify

 

1-Male

2-Female

9- If Participant Did Not Self-Identify or Identifies as "X" Other Gender Identity.

 

Record "1" if the participant is a person who served on active duty in the armed forces and who was discharged or released from such service under conditions other than dishonorable. A person who is on active duty is in the military full time. They work for the military full time, may live on a military base, and can be deployed at any time.


An individual in the Reserve or National Guard is not full time active duty military personnel, although they can be deployed at any time should the need arise.


Record "0" if the participant does not meet the condition described above.


Record "9" if participant does not disclose veteran status..

 

1-Attained secondary school diploma

2-Attained secondary school equivalency (GED/TASC)

3-Participant with a disability received a certificate of attendance/completion as a result of successfully completing an Individualized Education Program (IEP)

4-Completed one of more years of post-secondary education

5-Attained a post-secondary technical or vocational certificate (non-degree)

6-Attained an Associate degree

7-Attained a Bachelor's degree

8-Attained a degree beyond a Bachelor's degree

0-No higher education completed

 

0-No Grades Completed 1-1st Grade 2- 2nd Grade 3-3rd Grade 4-4th Grade 5-5th Grade 6-6th Grade 7-7th Grade 8-8th Grade 9-9th Grade 10-10th Grade 11-11th Grade 12-12th Grade


Leave blank if highest school grade completed is not available.

 
 

Anyone may register for a community-based training to gain skills needed to enter an apprenticeship occupation.


Incumbent worker pre-apprenticeship supports the selection of Registered Apprentices from a registered sponsor/signatory’s current employment base.


If an incumbent worker enrolls in a community-based training program, select “hybrid.” If the agreement was approved for community-based training all participants should reflect either “community-based training” or “hybrid.”

 
 

If employer was listed, provide address of employer.


If participant was never employed, enter "N/A".

 

Enter job title for position at employer listed above.


If participant was never employed, enter "N/A".

 

Enter job duties of participant for position at employer listed above in 50 words or less.


If participant was never employed, enter "N/A".

 

Enter wage of participant at employer listed above. May be entered as hourly or annual.


If participant was never employed enter "N/A".

 

Enter as YYYYMMDD or "N/A"

 

If employer was listed, is job full-time or part-time?


1- Full-Time (>30 hours/week)


2- Part-Time (<30 hours week)


0- Never employed or no longer employed

 

Select all that apply. NYS apprenticeable trades: https://labor.ny.gov/apprenticeship/general/occupations.shtm

 

Enter as First Name Last Name.

 

Enter phone number in the following format 555-555-5555.

 
 

Each participant must sign a Participant Information Release Form.


Check this box to certify it has been signed and attached.

 

I certify that to the best of my knowledge, the provided information is true and accurate.

 

Please attach the signed "Participant Information Release Form." Please save as a single PDF and use the file naming convention "date_participantlastname_release.pdf" such as "20200312_Doe_release.pdf" (date should be date of submittal).

Drop your files here