City of Racine Pre-Apprenticeship Scholarship Application 2022

Name *

Email Address *

Date Of Birth *

Street Address *

City *

ZIP Code *

Phone Number *

Please Confirm Your Email Address *

How did you learn about the City of Racine Pre-Apprenticeship Scholarship Opportunity? * How did you learn about the City of Racine Pre-Apprenticeship Scholarship Opportunity? * WRTP/Big Step First Choice Pre-Apprenticeship Racine Family YMCA Gateway Technical College City of Racine Facebook page Mayor Mason Facebook page Racine Unified School District Racine County Human Services W-2 Caseworker FoodShare Caseworker Friend/Family Member Instagram Facebook News story (newspaper, TV, radio) Other

Race (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Race (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * African American or Black White Asian or Pacific Islander Native American Multiple Races Other

Ethnicity (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Ethnicity (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Hispanic Non-Hispanic

Primary Language (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Primary Language (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * English Spanish Other

Gender (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Gender (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Male Female Nonbinary Transgender Prefer Not to State Other

Are you a City of Racine resident? (Before answering, please confirm by looking up your street address in https://myvote.wi.gov/en-us/ - if that site tells you that residents at that address vote at a City of Racine polling place, you are a City resident; if it tells you that you vote at a Mt Pleasant, Caledonia, Wind Point, etc. polling place, then you are not a City of Racine resident and are not eligible for these scholarships) * Are you a City of Racine resident? (Before answering, please confirm by looking up your street address in https://myvote.wi.gov/en-us/ - if that site tells you that residents at that address vote at a City of Racine polling place, you are a City resident; if it tells you that you vote at a Mt Pleasant, Caledonia, Wind Point, etc. polling place, then you are not a City of Racine resident and are not eligible for these scholarships) * Yes No

Household Annual Income (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Household Annual Income (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * $0-10,000 $10,001-20,000 $20,001-30,000 $30,001-40,000 $40,001-50,000 $50,000+ $60,000+ $70,000+

Are you a parent of a child under 18 years old? (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Are you a parent of a child under 18 years old? (This question is asked for demographic purposes only and does not impact your scholarship eligibility) * Yes No

Total number of adults & children in your household (This question is asked for demographic purposes only and does not impact your scholarship eligibility) *

Last high school attended * Last high school attended * Washington Park J.I. Case Horlick St. Catherine Lutheran Walden REAL School Other

Last grade/education completed * Last grade/education completed * 9th 10th 11th High School Diploma High School Equivalency Degree (HSED) GED Associate's Degree Bachelor's Degree Other

Do you have a valid Wisconsin Driver's License or Permit? * Do you have a valid Wisconsin Driver's License or Permit? * Yes, I have a valid WI Driver's License Yes, I have a valid WI Driver's Permit No, I do not have a valid WI Driver's License or Permit

Do you have your own reliable transportation? * Do you have your own reliable transportation? * Yes No

Tell us briefly why you want to start a career in the building/construction trades. *

Tell us how receiving a City scholarship for a pre-apprenticeship training program will help you participate in the program and achieve your goals. *

Do you understand that if you receive a City scholarship, you will need to: 1) Sign a Scholarship Acknowledgement Form; 2) Complete and submit a W-9 form with a valid Social Security Number (SSN) or Individual Tax Identification Number (ITIN); 3) Provide proof of residency in the City of Racine; and 4) Remain a City resident while participating in one of the pre-apprenticeship training programs? * Do you understand that if you receive a City scholarship, you will need to: 1) Sign a Scholarship Acknowledgement Form; 2) Complete and submit a W-9 form with a valid Social Security Number (SSN) or Individual Tax Identification Number (ITIN); 3) Provide proof of residency in the City of Racine; and 4) Remain a City resident while participating in one of the pre-apprenticeship training programs? * Yes No

If you are awarded a City scholarship, would you be willing to work with the free, professional counselors at the Racine Financial Empowerment Center (FEC) to receive free, confidential financial counseling? * If you are awarded a City scholarship, would you be willing to work with the free, professional counselors at the Racine Financial Empowerment Center (FEC) to receive free, confidential financial counseling? * Yes No Maybe I'm already working with the Racine FEC!

Have you already enrolled in a pre-apprenticeship training program? * Have you already enrolled in a pre-apprenticeship training program? * No Yes, I have enrolled in WRTP/Big Step's Roadbuilding Training Program Yes, I have enrolled in the Racine Family YMCA's First Choice Pre-Apprenticeship Program