Home Visitor Apprenticeship Program Interest Form
Please fill out this Interest Form so that we can follow up with you if you are interested in applying to the program.
Street Address Line 2
State / Province
Postal / Zip Code
Alt. Phone Number
Which Home Visitation Orientation Session did you attend/plan to attend?
I attended on Tuesday, May 11th at 6:00pm
I attended on Thursday, May 20th at 6:00pm
I plan to attend on Tuesday, May 11th at 6:00pm
I plan to attend on Thursday, May 20th at 6:00pm
I did not/can not attend.
Are you eligible to apply to the Home Visitor Apprenticeship Program? Please check all that apply.
I am 18 years old or older.
I have earned a high school diploma or the equivalent.
I am able to speak, read, and write in English.
I am a former home visitor program participant OR I have alternative life experiences that I think may qualify me to participate in this program.
I am willing to complete all necessary health, background, and drug checks.
I am available to participate in the program Monday - Friday, 8 am – 3 pm, August 2021- December 2022.
Which of the participating two agencies are you considering applying to be an apprentice?
Do you have any questions or concerns?
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