Pre-Apprenticeship Program

U.S. Department of Labor

Employment and Training Administration

Office of Apprenticeship

Pre-Apprenticeship —

Contact and Program Information

OMB Approval No. 1205-0520

Expiration Date: 08/31/2018

Contact Information

Program Name: ______________________________________

Program Address: ____________________________________

Program Phone Number: ______________________________

Program Email Address: _______________________________

Program Website: ____________________________________

Primary Contact Name: ________________________________

Primary Contact Phone Number: _________________________

Primary Contact Email Address: __________________________

Secondary Contact Name: _______________________________

Secondary Contact Phone Number: _______________________

Secondary Contact Email Address: ________________________

Program Information

1. Does your program currently provide preparatory or remedial training for an apprenticeship program?

• Yes

• No

If yes, does your pre-apprenticeship program have an articulation agreement with an apprenticeship program?

If yes, do your pre-apprenticeship program completers get direct entry and/or automatic placement into an apprenticeship program?

Please list the program(s)

• RAP Program Name: ______________________________________

• Program Address: ____________________________________

• Program Phone Number: ______________________________

• Program Email Address: _______________________________

• Program Website: ____________________________________

• Primary Contact Name: ________________________________

• Primary Contact Phone Number: _________________________

• Primary Contact Email Address: __________________________

2. What is/are the source/s of your financial support?

• Workforce Innovation and Opportunity Act (WIOA)

• Federal training program other than WIOA

• State and/or Local Government (grant or contract)

• Foundation

• Fee for service

• Other

If other, what is the other source?

________________________________________________________

3. Who is the training provider for your program? If the training provider and the operator of the pre-apprenticeship program are the same, select the category below that best describes the operator of the pre-apprenticeship program:

• Community college

• High school

• On-line learning program

• Company

• Community-based organization

• Other

4. Please list the contact information for the training provider

• Training Provider Name: ______________________________________

• Program Address: ____________________________________

• Program Phone Number: ______________________________

• Program Email Address: _______________________________

• Program Website: ____________________________________

• Primary Contact Name: ________________________________

• Primary Contact Phone Number: _________________________

• Primary Contact Email Address: __________________________

5. Does your program charge for the pre-apprenticeship training?

• Yes

• No

6. If yes, please state how much you charge for the pre-apprenticeship training. ________________________

7. How many pre-apprenticeship clients do you serve annually? ___________

8. What percentage of your pre-apprenticeship clients complete the program?

9. Which population(s) does your program serve? (Select all that apply)

• Women

• Men

• Minorities

• Out-of-School Youth (16 to 24 year olds)

• High School Students

• People with Disabilities

• Ex-Offenders

• Veterans

• Other

10. What is the average age of the target demographic for your program?

• 16-24

• 25-35

• 35+

11. During each of the last five years, how many individuals has your pre-apprenticeship program placed into apprenticeships on average, each year?

12. How many pre-apprentices were placed into apprenticeship during the last twelve months?_____________.

13. What is the overall percentage of total pre-apprenticeship completers that are placed into apprenticeship programs?

14. Does your program have entry requirements? If so, please list them: _______________________

Program Curriculum

15. Can individuals who successfully complete the pre-apprenticeship program receive advance credit for skills already acquired after they enter an apprenticeship program?

• Yes

• No

16. Has your training and/or curriculum been reviewed or approved by an apprenticeship program sponsor or provider?

• Yes

• No

17. Do you have a training curriculum?

• Yes

• No

If yes, will the Office of Apprenticeship (OA) be able to obtain a copy, if requested?

________________________________________

18. Does your training lead to a certificate, credential or aid in the preparation for a credentialing/licensing exam?

• Yes

• No

If yes, please identify the certificate or credential and describe: ________________________________________

19. Has your program benefited from input offered by sources such as employer associations, unions, registered apprenticeship programs, industry-recognized apprenticeships or an education entity such as a high school, community college, four-year college or university, etc.?

• Yes

• No

If yes, please list those sources: ________________________________________

Program Services

20. Does your program provide supportive services or facilitate access to appropriate support services to the participants? (for example: financial coaching, ongoing career services, childcare assistance, transportation, etc.)

• Yes

• No

If yes, please list those supportive services: _________________________________________

21. Does your program conduct skill assessments and Adult Basic Education tests to determine eligibility of participants?

• Yes

• No

22. Does your program have a referral protocol in place to build basic skills and conduct remedial training for participants who did not score well on an assessment?

• Yes

• No

23. Does your program use participant readiness checklists or standards?

• Yes

• No

24. Does your program have a case manager on staff to refer participants to support programs?

• Yes

• No

25. Does your program have features that replicate a real work environment?

• Yes

• No

26. Can you attest that your program’s real work environment does not displace current workers?

• Yes

• No

27. Please describe how your program replicates a real work experience. _____________________

________________________________________________

28. Which industries are currently served by your program? (Select all that apply)

• Agriculture, Forestry, Fishing and Hunting

• Construction

• Educational Services

• Finance and Insurance

• Food Services

• Health Care and Social Assistance

• Information Technology

• Cybersecurity

• Leisure and Hospitality

• Manufacturing

• Mining, Quarrying, and Oil and Gas Extraction

• Public Administration

• Transportation

• Utilities

• Other Industries

29. For which occupation(s) does your program currently offer training? ______________________

_______________________________________________

This reporting requirement is approved under the Paperwork Reduction Act of 1995, OMB Control No. 1205-0520, expiring xx/xx/xxxx. According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The purpose of the information collection is to create a public database and website for the Pre Apprenticeship programs and it will be used to help highlight and promote these programs. Public reporting burden for this collection of information, which is voluntary, is estimated to average 14 minutes per application, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the information, including reviewing the information for updating once every three years. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Employment and Training Administration, Office of Apprenticeship, Room N-5311, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0520).

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