Birmingham Promise Apprenticeship Program Application

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The Birmingham Promise Apprenticeship Program aims to help students develop high-demand skills through paid work experience in four industries: finance and insurance, healthcare and life sciences, energy and engineering, and digital technology. The goal of the program is to develop pathways to quality jobs through hands-on learning in the workplace.

STUDENT PROFILE









DEMOGRAPHICS





PARENT/LEGAL GUARDIAN





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ESSAY


INDUSTRY CERTIFICATIONS 


CAREER INTEREST


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We offer paid opportunities in four sectors: Business and Finance, Energy and Engineering, Healthcare and Lifesciences, and Information Technology. Please rank your interest in each field below:




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TRANSPORTATION 



ORIENTATION 



DISCLOSURE

Authorization and Disclosure Consent: I authorize any of the participating institutions in the Birmingham Promise program to release and share any and all of my financial aid, demographic, or academic information, in whole or in part, to the Birmingham Promise Program and its participating institutions, including Birmingham Promise, Inc., and its staff and contractors, and Birmingham City Schools and its individual schools, for the purpose of facilitating their analysis of my eligibility for the Promise program and the operation and educational and economic impact of the program on the City of Birmingham. The information to be shared may include:
  • name
  • home address
  • email addresses
  • telephone number
  • date and place of birth
  • major field of study
  • grade point average
  • number of credit hours per semester
  • dates of enrollment
  • degree(s) awarded
This release is authorized for the duration of the time beginning when I begin an application and continuing while I receive funds, participate in an apprenticeship or otherwise remain a participant in the Promise program. In order to rescind this Authorization, I acknowledge that I must submit written notification of rescission to Birmingham Promise, Inc. This rescission may result in the termination of my receipt of benefits of the Promise program. I understand that I have the right to request a copy of any records disclosed or shared.

I understand that Birmingham Promise will be evaluated by a third party researcher. I understand that, as part of this evaluation, the Birmingham Promise will share my student record data (including personal identifiers) and program participation data with the evaluator. I understand that Birmingham Promise will also collect data from the National Student Clearinghouse, which has information on enrollment and degrees received at most colleges in the country. I also understand that Birmingham Promise may collect earnings and employment data from state employment agencies. I understand that Birmingham Promise may collect these data for up to 10 years. I understand that any information that Birmingham Promise collects for the study will be kept confidential and will be used for research purposes only. In addition, I understand that Birmingham Promise may contact me to participate in a survey, interview, or focus group about my experiences. Furthermore, I give permission to the Birmingham Promise to use information, including records, photos, interviews, videos and images in promotion of the Birmingham Promise.


UPLOAD STUDENT RESUME


STUDENT REFERENCES

Please list the names and email addresses of two (2) references. Please include:
  • One from a school representative (examples: teacher, counselor or administrator)
  • One from a representative in your community (examples: neighborhood officer, coach, church pastor, civic leader, etc.)
The references you enter below will be emailed a recommendation form to complete and return.