SUCCEED
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2024-2025 SUCCEED Apprentice Application Form
SUCCEED Apprenticeship Program Application.
*
Student's first name:
*
Student's last name:
Student's gender:
Not required - for statistical purposes only
Male
Female
Select None
Student's ethnicity:
Not required - for statistical purposes only
African-American
Asian or Pacific Islander
Caucasian
Hispanic
Mixed Ethnicity
Native American
Select None
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Student's age:
Select...
9
10
11
12
13
14
15
16
17
18
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Student's grade:
If you are a home school student, estimate an approximate grade level
Select...
5
6
7
8
9
10
11
12
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School name:
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School type:
public
private
home school
other
Please include any medical issues that we may need to know:
Parent or Guardian Information:
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Parent's first name:
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Parent's last name:
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Street address:
Street address, second line:
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City:
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State:
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ZIP code:
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Parent's email address:
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Confirm parent's email address:
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Parent's daytime phone number:
example: 919-555-9999
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Parent's evening phone number:
same format as above
Additional Information:
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Describe your experiences in science and mathematics (classes, self-study, extracurricular programs, summer activities, etc.). What do you like most about science or mathematics?
*
Describe why you wish to participate in the Apprenticeship program and what you hope to accomplish:
Additional comments:
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